Abstract
The aim of the study was to evaluate whether pretherapeutic metabolic tumor parameters from 18-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging could predict larynx preservation in laryngeal and hypopharyngeal cancer patients prior to primary chemoradiation. Tumor metabolic parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)] were retrospectively assessed in a consecutive cohort of laryngeal and hypopharyngeal cancer patients undergoing primary (chemo-)radiation. Main outcome measures were larynx preservation and survival. The study included 97 patients with a median follow-up of 32 months (IQR 20–54.5). For hypopharyngeal cancer, multivariable analysis showed that patients with a primary tumor’s SUVmax > 9.5 entailed a higher risk of undergoing salvage pharyngolaryngectomy after chemoradiation (HR = 8.64, 95% CI = 1.1–67.3, P = 0.040). In laryngeal cancer, SUVmax did not predict the need for salvage laryngectomy. The only predictor for larynx preservation in laryngeal cancer patients was T-classification at initial diagnosis (HR = 6.67, 95% CI = 0.82–53.9, P = 0.039). In conclusion, SUVmax of primary tumor could be used as a predictor of larynx preservation prior to primary chemoradiation in hypopharyngeal cancer patients. This information may be important for patient counseling, as high SUVmax was correlated with reduced probability of larynx preservation. However, in laryngeal cancer patients, SUVmax does not seem to be predictive of outcome.
Highlights
18-fluorodeoxyglucose positron emission tomography (FDG-PET) with computed tomography (CT) or magnetic resonance (MR) imaging has become a broadly accepted imaging tool in routine clinical oncology[6]
This study evaluates whether pretherapeutic metabolic parameters of laryngeal and hypopharyngeal cancer patients can predict tumor response to chemoradiation
Pretherapeutic SUVmax of the primary tumor was a predictor of laryngeal preservation before chemoradiation in hypopharyngeal cancer but did not seem to be predictive of organ preservation in laryngeal cancer
Summary
18-fluorodeoxyglucose positron emission tomography (FDG-PET) with computed tomography (CT) or magnetic resonance (MR) imaging has become a broadly accepted imaging tool in routine clinical oncology[6]. Adding FDG-PET to the staging process resulted in higher staging accuracy with improved nodal classification[7,8], superior detection of regional or distant metastases, and second primary cancers[9,10]. Metabolic tumor parameters derived from FDG-PET have been suggested to serve as prognostic markers for the response www.nature.com/scientificreports/. Tumors with a higher uptake of FDG have a more active tumor metabolism, which negatively correlates with tumor oxygenation through the Warburg effect[15,16]. We hypothesized that FDG-PET derived tumor metabolism markers, such as SUVmax, MTV, and TLG, can be used as predictors of response to chemoradiation. The aim of this study was to examine whether different pretherapeutic FDG-PET parameters can predict organ preservation in laryngeal and hypopharyngeal cancer undergoing primary chemoradiation
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