Abstract
ObjectiveThe objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN).Methods and findingsA prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA–B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056–0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040–0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062–0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013–0.96; p = 0.046) survival.ConclusionsThese results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes.
Highlights
Metabolic 18F-FDG PET/computed tomography (CT) tumor response in head and neck cancer. These results suggest a potential role for early response evaluation with Positron emission tomography/Computed tomography (PET/CT) examination in patients with LASCCHN undergoing induction chemotherapy (IC)
In the last decade, randomized trials comparing induction chemotherapy (IC) regimens where taxanes were added to cisplatin and fluorouracil (TPF) to the previous standard, cisplatin plus fluorouracil (PF), regimen demonstrated improved outcomes favoring taxane-containing triplet regimens and led to the introduction of IC with triplet regimens followed by radiotherapy as a treatment option for patients with LASCCHN
Endoscopic, and radiological tumor response evaluation to IC-CT RT for LASCCHN is usually performed after 2-IC cycles, based on the anatomic World Health Organization (WHO) or modified WHO criteria, in which a partial response requires a bi-dimensional decrease in the target lesion of 50% and 25%, respectively, and neither increase in the regional neck lymph node lesions, nor evidence of distant metastasis
Summary
The objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN)
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