What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant ... View Full Text


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Article Info

DATE

2018-06-09

AUTHORS

Pierluigi Bonomo, A. Merlotti, E. Olmetto, A. Bianchi, I. Desideri, A. Bacigalupo, P. Franco, C. Franzese, E. Orlandi, L. Livi, S. Caini

ABSTRACT

PURPOSE: Evidence 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. METHODS: A 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. RESULTS: The 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. CONCLUSION: FDG 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. More... »

PAGES

2122-2138

References to SciGraph publications

  • 2002-02-12. FDG–PET. A possible prognostic factor in head and neck cancer in BRITISH JOURNAL OF CANCER
  • 2016-12-21. Nodal parameters of FDG PET/CT performed during radiotherapy for locally advanced mucosal primary head and neck squamous cell carcinoma can predict treatment outcomes: SUVmean and response rate are useful imaging biomarkers in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2015-01-28. Comprehensive genomic characterization of head and neck squamous cell carcinomas in NATURE
  • 2011-04-02. Can FDG PET predict radiation treatment outcome in head and neck cancer? Results of a prospective study in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2015-06-17. Prognostic role of metabolic parameters of 18F-FDG PET-CT scan performed during radiation therapy in locally advanced head and neck squamous cell carcinoma in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2014-09-17. Definitive chemo-radiotherapy for squamous cell carcinoma of the pharynx: impact of baseline low hemoglobin level (<12 g/dL) and post-radiation therapy F-18 FDG-PET/CT in ANNALS OF NUCLEAR MEDICINE
  • 2014-12-02. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0 in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2016-02-24. Dynamic contrast-enhanced MRI, diffusion-weighted MRI and 18F-FDG PET/CT for the prediction of survival in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation in EUROPEAN RADIOLOGY
  • 2016-10-11. Imaging biomarker roadmap for cancer studies in NATURE REVIEWS CLINICAL ONCOLOGY
  • 2016-02-17. Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study in BMC CANCER
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    http://scigraph.springernature.com/pub.10.1007/s00259-018-4065-5

    DOI

    http://dx.doi.org/10.1007/s00259-018-4065-5

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29948105


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    22 schema:description PURPOSE: Evidence is conflicting on the prognostic value of <sup>18</sup>F-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. METHODS: A 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. RESULTS: The 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 (I<sup>2</sup> &gt; 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUV<sub>max</sub> and any of the outcome measures. CONCLUSION: FDG 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.
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    30 FDG positron emission tomography
    31 High pretreatment metabolic tumour volume
    32 III/IV disease
    33 IV disease
    34 PET metrics
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    37 advanced disease
    38 advanced head
    39 aim
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    41 association
    42 available data
    43 baseline FDG PET metrics
    44 carcinoma
    45 cell carcinoma
    46 chemoradiotherapy
    47 conclusion
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    49 context
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    51 cumulative threshold
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    53 data
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    55 disease
    56 efficacy outcome measures
    57 emission tomography
    58 estimates
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    60 fluorodeoxyglucose positron emission tomography
    61 frequent primary tumor site
    62 head
    63 heterogeneity
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    66 lack
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    70 majority
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    75 metabolic variables
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    78 neck squamous cell carcinoma
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    82 outcomes
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    84 parameters
    85 patient outcomes
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    88 pretreatment metabolic tumor volume
    89 primary tumor site
    90 prognosis
    91 prognostic impact
    92 prognostic relevance
    93 prognostic value
    94 progression-free survival
    95 qualitative metabolic parameters
    96 relative risk
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    101 significant association
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    103 sites
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    105 stage III/IV disease
    106 standard concurrent chemoradiotherapy
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    115 threshold
    116 tomography
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