Abstract
Background and objectives: The importance of induction chemotherapy (ICT) followed by concurrent chemoradiotherapy (CCRT) has been re-established in recent years aiming at fewer metastatic sites and better control of the disease. We prospectively studied the possibility of early prediction of overall survival (OS) and progression-free survival (PFS) after 3 cycles of chemotherapy with doxetacel, cisplatin and 5-fluorouracil using 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (18F-FDG PET/CT) in patients with head and neck squamous cell cancer. To our knowledge, this is the first such study. Materials and Methods: Thirty-five patients were studied. They underwent an 18F-FDG PET/CT examination twice: a day before ICT and 10–14 days after the last cycle of ICT. Tumor-standardized uptake value (SUVmax) and hypermetabolic tumor volume were measured on both scans. The mean age of patients was 56.5 years. Complete responses to CCRT PFS and OS were calculated. Results: Our results showed that a decrease of ≥30% in the SUVmax value after ICT was a prognostic factor of tumor response to PFS and OS (p = 0.026 and p = 0.021). The groups of patients with a SUVmax between 10 and 14.5 in the primary tumor on a pre-ICT 18F-FDG PET/CT scan had statistically shorter PFS and OS (p = 0.001, p = 0.006) when compared with other groups of patients with SUVmax less than 10 or SUVmax more than 14.5. A decrease of less than 55% of hypermetabolic tumor volume of the primary tumor was significantly related to poor prognosis in PFS and OS (p = 0.033, p = 0.017). Conclusions: SUVmax and hypermetabolic tumor volume measured on 18F-FDG PET/CT after ICT might be valuable prognostic tools for predicting OS and PFS and, thus, for the selection of patients with head and neck cancer who will benefit from CCRT.
Highlights
The first treatment method for every cancer is surgery
The decrease of SUVmax less than 30% in primary tumors evaluated by 18 F-FDG PET/CT was a significant factor of poor prognosis in the group of non-responders for progression-free survival (PFS) and overall survival (OS)
We found that the group of non-responders, which showed significantly poor PFS and OS when when the primary tumor response was evaluated according to SUVmax, showed a the primary tumor response was evaluated according to SUVmax, showed a hypermetabolic hypermetabolic tumor volume decrease
Summary
The first treatment method for every cancer is surgery. head and neck squamous cell carcinomas (HNSCC) are not easy to resect and are associated with severe post-surgical complications and distortions of anatomical structures, which lead to worsening patients’ quality of life [1,2]. Gavid et al.’s (2015) study demonstrated that pre-treatment or post-treatment 18 F-FDG PET/CT uptake parameters such as standardized uptake value (SUV) and hypermetabolic tumor volume might be more advantageous and can predict response with higher sensitivity compared with morphological changes on CT [17]. Several clinical studies have demonstrated that the same 18 F-FDG PET/CT parameters may help to predict the tumor’s response to ICT and patients’ survival [5,10,17]. We made an assumption that changes in 18 F-FDG PET/CT parameters after ICT may be used to identify patients who will benefit from further treatment with CCRT. The aim of this prospective study was to assess effectiveness of early prediction of CCRT outcome by means of interim 18 F-FDG PET/CT in patients with unresectable HNSCC focusing on patient survival and clinical outcomes. It is worth mentioning that there are only few published retrospective studies where both SUVmax and hypermetabolic tumor volume were included into treatment response evaluation [17,18]
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