PET in head and neck RT
Prediction of prognosis using standardized uptake value of 2-[18F] fluoro-2-deoxy-d-glucose positron emission tomography for nasopharyngeal carcinomas

https://doi.org/10.1016/j.radonc.2008.01.009Get rights and content

Abstract

Purpose

To evaluate the prognostic significance of 2-[F-18]fluoro-2-deoxy-d-glucose positron emission tomography ([18F]FDG-PET) at diagnosis by calculating maximal standard uptake values (SUVmax) in patients with non-disseminated nasopharyngeal carcinoma (NPC) receiving concurrent chemo-radiotherapy (CCRT).

Materials and methods

[18F]FDG-PET was performed in 41 patients with non-disseminated NPC scheduled to undergo platinum-based CCRT. [18F]FDG uptake by primary tumors and neck nodes was measured with the SUVmax.

Results

Complete response occurred in all 41 patients. The ten patients who presented with any component of treatment failure had a significantly higher SUVmax than the remaining patients. The median SUVmax of all patients was 6.48 (range: 2.31–26.07). Patients having tumors with high [18F]FDG uptake (median or greater) had a significantly lower 3-year disease free survival (DFS) rate than patients with lower tumor [18F]FDG uptake (less than median) (51% vs 91%, P = 0.0070). Patients with an SUVmax below 8 had a higher DFS than patients with an SUVmax of 8 or greater.

Conclusion

[18F]FDG uptake, as measured by the SUVmax, may predict DFS in CCRT-treated NPC. High [18F]FDG uptake may be useful for identifying patients requiring more aggressive treatment.

Section snippets

Patients

We retrospectively analyzed the medical records of 41 patients with non-disseminated NPC who were referred for definitive RT to the Department of Radiation Oncology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea, between November 2001 and December 2003. Eligible patients were those with biopsy-proven SCC, including those with poorly differentiated and undifferentiated carcinomas, who had received definitive RT combined with concurrent chemotherapy. In addition,

Demographic data

Patient characteristics are summarized in Table 1. The median patient age was 48 years (range, 17 to 78 years). Of the 41 patients, 35 were men and 6 were women, all of whom underwent curative RT; 3 for stage I, 8 for stage II, 18 for stage III and 12 for stage IV tumors. Histologically, 1 tumor was WHO type I, 10 were WHO type II, 25 were WHO type III, and 5 were unspecified. Of the 41 patients, 36 (88%) received cisplatin based CCRT. Based on WHO criteria, all patients showed a clinically

Discussion

Although NPC is highly sensitive to RT or chemotherapy, the 3-year progression free survival rate for patients treated with CCRT was found to be 69% [3]. Improving treatment outcomes requires the identification of factors predictive of better prognosis. Among the prognostic factors of NPC are stage group, neck node involvement, intracranial extension, cranial nerve involvement and parapharyngeal involvement, none of which could predict outcome. The identification of additional prognostic

Acknowledgments

Poster presented at the 3rd annual meeting of The Academy of Molecular Imaging, Orlando, FL, USA, March 18-22, 2005. This study was supported by a Grant (02-PJ1-PG3-20802-0009) from the Ministry of Health and Welfare, Republic of Korea.

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