Volumetric ¹⁸F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

Abstract

Background We sought to investigate the prognostic value of volumetric positron emission tomography (PET) parameters in patients with human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC) and a ≤10 pack‐year smoking history treated with chemoradiation. Methods A total of 142 patients were included. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor, involved regional lymph nodes, and total lesion were calculated. Cox proportional hazard modeling was used to evaluate associations of clinical and PET parameters with locoregional failure‐free survival (LRFFS), distant metastasis‐free survival (DMFS), and overall survival (OS). Results On univariate analysis, volumetric PET parameters were significantly associated with all endpoints, and 8th edition American Joint Committee on Cancer/Union Internationale Contre le Cancer staging was significantly associated with DMFS and OS. On multivariate analysis, total lesion TLG was significantly associated with LRFFS, while staging was most significantly prognostic for DMFS and OS. Conclusion Volumetric PET parameters are uniquely prognostic of LRFFS in low‐risk HPV‐related OPSCC and may be useful for directing de‐intensification strategies.

Predictive Values of MRI and PET Derived Quantitative Parameters for Patterns of Failure in Both p16+ and p16– High Risk Head and Neck Cancer

“…Pretreatment FDG QI metrics, including MTV, TLG and mean/max, have been reported to be correlated with PFS and OS in the patients with HN cancers treated with CRT (3–6). We found that the high mean/max SUV and large TLG in nodal tumors were risk factors for nodal failure, and that the sum of TLG over all nodal MTVs was a negative prognostic factor for DFFS, which is consistent with several previous reports (2–4). Although TLG accounts for both the size and SUV of MTV, we found that nodal TLG was strongly correlated with MRI-defined GTV, and nodal GTV was the strongest predictor for RF in our study.…”

“…This cohort of 54 patients with locally advanced HNSCC had large primary GTVs with a median value of 60.5 cc (range: 10.2–595.2 cc; SD: 86.8 cc; Table 1), which was several times greater than most reported studies (2–6, 9–11, 33). Eleven patients (20%) (3 p16+) have had local recurrence.…”

“…In this study, we investigated p16 effects on MRI and PET QI metrics, imaging biomarker differences as a function of tumor control (local, regional, or distant), and the predictive values between MRI and PET biomarkers for tumor progression in locally advanced poor prognosis HN cancers. Our cohort of patients had large tumor volumes compared to previously reported literature (2–6, 9–11, 33). We found the p16– primary tumors had elevated ADC values pre-RT and low early response rates compared to p16+ tumors; the latter of which has not been previously reported.…”

“…We and others have been developing prognostic and predictive imaging markers of PET and MRI for LRF, distant metastases, progression free survival (PFS), and overall survival (OS) (2-20). Retrospective studies of pre-treatment FDG-PET that quantify cellular glucose metabolism have identified metabolic tumor volume (MTV), total lesion glycolysis (TLG), and mean/max standard uptake value (SUV) in MTV as prognostic for LRF, PFS, and OS in HNSCC (2–6). Furthermore, FDG-PET has been incorporated into standard of care work-up and follow-up for HNSCC (7, 8).…”

Correlation between histogram-based DCE-MRI parameters and 18F-FDG PET values in oropharyngeal squamous cell carcinoma: Evaluation in primary tumors and metastatic nodes

“…Magnetic resonance imaging (MRI) and positron emission tomography with 18 F-fluorodeoxyglucose ( 18 F-FDG-PET) are the current diagnostic imaging methods for staging and treatment monitoring of HNSCC [3][4][5]. In recent years, dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) have also been introduced in clinical practice to obtain a more comprehensive characterization of HNSCC, based on functional parameters related to tissue microvascular properties and cellularity, respectively [6].…”