What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis

Abstract

PurposeEvidence is conflicting on the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of our study was to determine the impact of semiquantitative and qualitative metabolic parameters on the outcome in patients managed with standard treatment for locally advanced disease.MethodsA systematic review of the literature was conducted. A meta-analysis was performed of studies providing estimates of relative risk (RR) for the association between semiquantitative metabolic parameters and efficacy outcome measures.ResultsThe analysis included 25 studies, for a total of 2,223 subjects. The most frequent primary tumour site was the oropharynx (1,150/2,223 patients, 51.7%). According to the available data, the majority of patients had stage III/IV disease (1,709/1,799, 94.9%; no information available in four studies) and were treated with standard concurrent chemoradiotherapy (1,562/2,009 patients, 77.7%; only one study without available information). A total of 11, 8 and 4 independent studies provided RR estimates for the association between baseline FDG PET metrics and overall survival (OS), progression-free survival (PFS) and locoregional control (LRC), respectively. High pretreatment metabolic tumour volume (MTV) was significantly associated with a worse OS (summary RR 1.86, 95% CI 1.08–3.21), PFS (summary RR 1.81, 95% CI 1.14–2.89) and LRC (summary RR 3.49, 95% CI 1.65–7.35). Given the large heterogeneity (I2 > 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUVmax and any of the outcome measures.ConclusionFDG PET has prognostic relevance in the context of locally advanced head and neck squamous cell carcinoma. Pretreatment MTV is the only metabolic variable with a significant impact on patient outcome. Because of the heterogeneity and the lack of standardized methodology, no definitive conclusions on optimal cut-off values can be drawn.Electronic supplementary materialThe online version of this article (10.1007/s00259-018-4065-5) contains supplementary material, which is available to authorized users.

Predictive value of quantitative 18F-FDG-PET radiomics analysis in patients with head and neck squamous cell carcinoma

“…Radiotherapy with or without chemotherapy is frequently applied but fails in 50% of the cases. In the vast majority (about 90%), the locoregional failure occurs within the first 2 years after treatment [2,3]. The consequence of recurrent cancer is that surgical salvage therapy is generally the only option with curative intent, but this is associated with high morbidity [4].…”

“…Positron-emission tomography (PET)/computed tomography (CT) using 18 F-fluoro-deoxy-glucose ( 18 F-FDG) measures tumoral metabolic activity and can be quantified with 18 F-FDG-PET/CT by the standard uptake value (SUV). Pretreatment 18 F-FDG-PET/CT was reported to be useful for detection, treatment decision support [14], planning [15,16], and the prediction and detection of recurrences and long-term outcome [2]. PET-radiomics was superior over a CT-based model (CI PET = 0.77 versus CI CT = 0.72) [17] and might improve lesion characterization and patient outcome prediction compared to first-order PET parameters in daily clinical routine [18][19][20][21].…”

PET-based prognostic survival model after radiotherapy for head and neck cancer

“…Among PET parameters, MTV correlates with OS and disease-free survival (DFS) with a prognostic value clearly greater than the SUV Max and less than the TLG [26,27]. However, the majority of studies supporting MTV as a prognostic factor are retrospective or single-centre studies and/or lack external validation.…”

Texture indices of 4′-[methyl-11C]-thiothymidine uptake predict p16 status in patients with newly diagnosed oropharyngeal squamous cell carcinoma: Comparison with 18F-FDG uptake

“…Positron emission tomography (PET) with 2-deoxy-2-18 F-uoro-d-glucose ( 18 F-FDG) is a useful functional tool for the diagnosis and surveillance of head and neck squamous cell carcinoma (HNSCC) (Bonomo et al, 2018). While 18 F-FDG directly re ects the glucose metabolism, Toyohara et al, developed 4¢-[methyl-…”