Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis in Head and Neck Cancer: A Systematic Review and Meta-Analysis

Abstract

We conducted a comprehensive systematic review of the literature on volumetric parameters and a meta-analysis of the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with head and neck cancer (HNC). Methods: A systematic search of MEDLINE and EMBASE was performed using the key words PET, head and neck, and volume. Inclusion criteria were 18 F-FDG PET used as an initial imaging tool; studies limited to HNC; patients who had not undergone surgery, chemotherapy, or radiotherapy before PET scans; and studies reporting survival data. Event-free survival and overall survival were considered markers of outcome. The impact of MTV or TLG on survival was measured by the effect size hazard ratio (HR). Data from each study were analyzed using Review Manager. Results: Thirteen studies comprising 1,180 patients were included in this study. The combined HR for adverse events was 3.06 (2.33-4.01, P , 0.00001) with MTV and 3.10 (2.27-4.24, P , 0.00001) with TLG, meaning that tumors with high volumetric parameters were associated with progression or recurrence. Regarding overall survival, the pooled HR was 3.51 (2.62-4.72, P , 0.00001) with MTV and 3.14 (2.24-4.40, P , 0.00001) with TLG. There was no evidence of significant statistical heterogeneity at an I 2 of 0%. Conclusion: MTV and TLG are prognostic predictors of outcome in patients with HNC. Despite clinically heterogeneous HNC and the various methods adopted between studies, we can confirm that patients with a high MTV or TLG have a higher risk of adverse events or death.

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

“…In contrast to the current study, larger prior studies in patients with HNSCC and EC have correlated worse outcomes with higher baseline SUVmax [14,[23][24][25]. Similarly, larger prior studies suggest that higher TLG values correlated with worse oncologic outcomes [24][25][26][27]. When analyzed by disease site in this study, no baseline PET characteristics correlated with outcomes.…”

Hypoxic glucose metabolism in glioblastoma as a potential prognostic factor

“…It may be argued that all that is needed is FDG PET for the purpose of measuring active tumor volume. In non-brain malignancies, FDG PET has been recently analyzed using volume-based parameters such as MTV and TLG [34]. These parameters, however, are difficult to measure for C-methionine PET is a well-known technique that can more accurately reflect the tumor volume than MRI [35].…”

Effects of Intratumoral Inflammatory Process on 18F-FDG Uptake: Pathologic and Comparative Study with 18F-Fluoro-α-Methyltyrosine PET/CT in Oral Squamous Cell Carcinoma

“…Together, 18 F-FDG MTV and TLG provide such potential in OSCC treated with chemoradiotherapy (32). Moreover, in a recent systematic review, both parameters are accurate prognostic indicators of outcome in head and neck cancer (33).…”