Pretreatment 18F-FDG uptake heterogeneity can predict treatment outcome of carbon ion radiotherapy in patients with locally recurrent nasopharyngeal carcinoma

Ma, Guoying; Gu, Bingxin; Hu, Jiyi; Kong, Lin; Zhang, Jiangang; Li, Zili; Xue, Yangbo; Lu, Jiade J.; Cao, Junning; Cheng, Jingyi; Zhang, Yingjian; Song, Shaoli; Yang, Zhongyi

doi:10.1007/s12149-021-01621-8

Cited by 8 publications

(101 citation statements)

References 38 publications

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“…Among the 26 included studies, nineteen reported prespecified survival outcomes, including OS (n = 16) [11,13,16,17,[19][20][21][22][23]26,27,29,30,32,34,35], PFS (n = 9) [16,19,20,22,24,28,30,33,34], LC (n = 10) [13,16,21,22,[26][27][28][29][30]35], and regional control (n = 3) [13,21,22]. Eighteen studies reported toxicity [11][12][13]16,17,[19][20][21][22][26][27][28][29]…”

Section: Discussionmentioning

confidence: 99%

“…Safety outcomes: a. Toxicity b. Gastrostomy tube dependency Ma, G. et al (2021; China) [24] 29 N/A N/A AJCC 7th ed. : I/II: 10 III/IVa: 19 29–69 (47) Recurrent NPC N/A (37) 2–3 GyE N/A 50–65 GyE CIBT N/A 1.…”

Section: Methodsmentioning

confidence: 99%

“…The 26 studies included a total of 1502 NPC patients, with sample sizes varying from 10 to 358. Seven papers had a patient size of 50 or more [13,[20][21][22]26,32,34], and only one of them had a sample size of [20,21,[23][24][25]29,32,36]. The remaining study included both [30].…”

Section: Participantsmentioning

confidence: 99%

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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“…However, these volume-based parameters have not been sufficiently evaluated because the results were varied and controversial. Some researches declared that TLG and MTV did not show significant prognostic value for NPC [ 10 , 11 , 19 ]. Thus, SUVmax has been the most widely used parameter because the advantages of high accuracy, convenient measurement, and good repeatability.…”

Section: Discussionmentioning

confidence: 99%

Reflecting on the utility of standardized uptake values on 18F-FDG PET in nasopharyngeal carcinoma

Qiu

et al. 2022

BMC Cancer

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Background To rethink the clinical significance of standardized uptake values (SUVs) of nasopharyngeal carcinoma (NPC) on 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography (PET). Methods We retrospectively reviewed 369 NPC patients who underwent pretreatment 18F-FDG PET. The predictive value of the SUVmax of the primary tumor (SUVmax-t) and regional lymph nodes (SUVmax-n) was evaluated using probability density functions. Receiver operating characteristic curves were used to determine optimal cutoffs for the SUVmax-n/SUVmax-t ratio (NTR). Kaplan–Meier and Cox regression analyses were used to assess survival. Results The optimal SUVmax-t and SUVmax-n cutoffs were 7.5 and 6.9, respectively. High SUVmax-t and SUVmax-n were related to local and regional recurrence, respectively. Patients with low SUVmax had better 3-year overall survival (OS). To avoid cross-sensitization of cutoff points, we stratified patients with high SUVmax into the low and high NTR groups. The 3-year distant metastasis-free survival (DMFS; 92.3 vs. 80.6%, P = 0.009), progression-free survival (PFS; 84.0 vs. 67.7%, P = 0.011), and OS (95.9 vs. 89.2%, P = 0.002) significantly differed between the high vs. low NTR groups for patients with high SUVmax. Multivariable analysis showed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR]: 2.037, 95% CI: 1.039–3.992, P = 0.038), PFS (HR: 1.636, 95% CI: 1.021–2.621, P = 0.041), and OS (HR: 2.543, 95% CI: 1.214–5.325, P = 0.013). Conclusion High SUVmax was associated with NPC recurrence. NTR is a potential prognosticator for DMFS, suggesting that heterogeneity in the pretreatment 18F-FDG uptake between the primary tumor and lymph nodes is associated with high invasion and metastatic potential.

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“…Usually, the GTV in NPC is evaluated using CT imaging. However, previous studies have found that 18F-FDG-PET/CT can greatly enhance the value of TNM staging, treatment assessment, and prognosis of NPC (24)(25)(26)(27)(28), and has been increasingly used to plan RT (29). Moreover, 18F-FDG-PET integrated with IMRT is more likely to facilitate target volume delineation and dose escalation (30), thereby being more favorable for the main clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Relevance of 18F-FDG-PET/CT-Guided Target Volume Delineation in Loco-Regionally Advanced Nasopharyngeal Carcinomas: A Comparative Study

et al. 2021

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IntroductionAn optimal approach to define tumor volume in locoregionally advanced nasopharyngeal carcinoma (NPC) using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) remains unclear. This retrospective study aimed at comparing the outcomes and toxicities of different FDG-PET/CT-guided techniques for primary tumor volume delineation in locoregionally advanced NPC.MethodsFrom August 2015 to February 2018, 292 patients with stage III-IVB NPC received FDG-PET/CT-guided IMRT. Three PET/CT-based techniques were used to determine the gross tumor volume (GTV) as follows: visual criteria (group A; n = 98), a standard uptake value (SUV) threshold of 2.5 (group B; n = 95), and a threshold of 50% maximal intensity (group C, n = 99) combined with a dose-painting technique.ResultsIn groups A, B, and C, the 5-year LRFS rates were 89.4%, 90.0%, and 97.8%, respectively (p = 0.043). The 5-year DMFS rates were 75.1%, 76.0%, and 87.7%, respectively (p = 0.043). The 5-year DFS rates were 70.9%, 70.3%, and 82.2%, respectively (p = 0.048). The 5-year OS rates were 73.5%, 73.9%, and 84.9%, respectively (p = 0.038). Group C showed significantly higher 5-year LRFS, LRRFS, DMFS, DFS, and OS than those in groups A and B (p < 0.05). No statistically significant differences were observed between the three study groups in the cumulative incidences of grade 3-4 acute and late toxicities. Multivariate analyses showed that the PET/CT-guided technique for target volume delineation was an independent prognostic factor for 5-year LRFS, DFS, DMFS, and OS (p = 0.039, p = 0.030, p = 0.035 and p = 0.028, respectively), and was marginally significant in predicting LRRFS (p = 0.080).ConclusionsThe 50% SUVmax threshold regimen for GTV delineation with dose-painting appeared to be superior to the visual criteria or SUV2.5 threshold in locoregionally advanced NPC, and there was no increased toxicity.

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Pretreatment 18F-FDG uptake heterogeneity can predict treatment outcome of carbon ion radiotherapy in patients with locally recurrent nasopharyngeal carcinoma

Cited by 8 publications

References 38 publications

Particle beam therapy for nasopharyngeal cancer: A systematic review and meta-analysis

Particle beam therapy for nasopharyngeal cancer: A systematic review and meta-analysis

Reflecting on the utility of standardized uptake values on 18F-FDG PET in nasopharyngeal carcinoma

Prognostic Relevance of 18F-FDG-PET/CT-Guided Target Volume Delineation in Loco-Regionally Advanced Nasopharyngeal Carcinomas: A Comparative Study

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