Abstract
Background and PurposeTo investigate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with laryngeal cancer.Materials and MethodsThe study included 51 patients of whom 30 underwent definitive radiotherapy with or without chemotherapy and 21 underwent radical surgery with or without adjuvant chemoradiation therapy. FDG uptake by both the primary lesion and the neck node was measured using the maximum standardized uptake value (SUVmax). The effects of clinicopathological factors including primary tumor SUVmax and nodal SUVmax on progression-free survival, local control, nodal progression-free survival, and distant metastasis-free survival were evaluated using the log-rank test and Cox method.ResultsThe median duration of follow-up was 48.6 months (range 8 to 82.1 months). Univariate analysis showed that nodal SUVmax, N status, and tumor TNM stage were significantly associated with recurrence, whereas primary tumor SUVmax, age, treatment strategy and T status were not. Multivariate analysis demonstrated that only the nodal SUVmax was a significantly unfavorable factor for progression-free survival (p = 0.029, hazard ratio 0.54, 95% CI 0.38-0.87) and nodal progression-free survival (p = 0.023, hazard ratio 0.51, 95% CI 0.34-0.81). ROC curve analysis and log-rank test showed that patients with a high nodal SUVmax (≧4) had a significantly lower progression-free survival rate than those with a low SUVmax (<4; p<0.0001).ConclusionsThe pretreatment SUVmax of nodal disease in patients with laryngeal cancer is prognostic for recurrence.
Highlights
Various treatment strategies are used to improve outcome in patients with squamous cell carcinoma of the head and neck
Univariate analysis showed that nodal SUVmax, N status, and tumor TNM stage were significantly associated with recurrence, whereas primary tumor SUVmax, age, treatment strategy and T status were not
Multivariate analysis demonstrated that only the nodal SUVmax was a significantly unfavorable factor for progression-free survival (p = 0.029, hazard ratio 0.54, 95% CI 0.38-0.87) and nodal progression-free survival (p = 0.023, hazard ratio 0.51, 95% CI 0.34-0.81)
Summary
Various treatment strategies are used to improve outcome in patients with squamous cell carcinoma of the head and neck. Selection of appropriate treatment strategies and prognostication remain difficult for clinicians, despite careful evaluation of clinical factors, TNM staging, and anatomic subsite. Identification of novel pretreatment imaging biomarkers that would potentially predict long-term outcome would be clinically significant. With the use of 18F-fluorodeoxyglucose (FDG), a glucose analog, positron emission tomography (PET) allows non-invasive assessment of glucose metabolism in a wide variety of tumor types including head and neck cancer. Analyses of metabolic parameters, which are independent of morphologic changes, are expected to offer an important opportunity to predict individual tumor behavior. To investigate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with laryngeal cancer
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