The role of interim FDG PET-CT after induction chemotherapy as a predictor of concurrent chemoradiotherapy efficacy and prognosis for head and neck cancer

Ka-Rham Kim,Ik-Joo Chung,Jun-Eul Hwang,Sang-Hee Cho,Sae-Ryung Kang,Ki Seong Park,Seong Young Kwon,Hyun-Jeong Shim,Woo Kyun Bae,Woong-Ki Chung

doi:10.1007/s00259-017-3836-8

Ka-Rham Kim, Ik-Joo Chung + Show 8 more

Open Access

https://doi.org/10.1007/s00259-017-3836-8

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Abstract

PurposeInduction chemotherapy (ICT) with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiotherapy (CCRT) has the advantages of organ preservation and systemic control in head and neck cancer (HNC). Early prediction of CCRT efficacy may help identify patients who will benefit more from surgery than from CCRT. We investigated the role of interim 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (FDG PET-CT) after ICT to predict the efficacy of CCRT and clinical outcomes.MethodsTumor responses were retrospectively reviewed after CCRT based on the Response Evaluation Criteria in Solid Tumors. FDG PET-CT imaging was performed before and after three cycles of TPF. We examined the associations between the metabolic response (percentage decrease in the maximum standardized uptake value [SUVmax] and total metabolic tumor volume [MTV]) after ICT and complete response (CR) to CCRT, progression-free survival (PFS), and overall survival (OS).ResultsWe studied 43 HNC patients with a median follow-up of 32.7 months. Lymph node (LN) SUVmax and total MTV decreases from baseline after ICT were greater in patients with a CR to CCRT than in non-CR patients (LN SUVmax, 88.8% vs. 62.5%, respectively; total MTV, 99.7% vs. 89.9%, respectively). Decreases in total MTV ≥ 78% and LN SUVmax ≥73% after ICT predicted CR to CCRT and longer OS and PFS.ConclusionsUsing interim FDG PET-CT to measure SUVmax and total MTV after three cycles of ICT may be a useful technique for identifying HNC patients who will benefit from CCRT and predicting survival outcomes.

Highlights

Concurrent chemoradiotherapy (CCRT) is the standard treatment for nonsurgical management of locally advanced head and neck cancer (HNC) [1]
Using interim FDG PET-CT to measure SUVmax and total Metabolic tumor volume (MTV) after three cycles of induction chemotherapy (ICT) may be a useful technique for identifying HNC patients who will benefit from CCRT and predicting survival outcomes
Previous studies have reported an association between ICT and fewer distant metastases [3] and a higher radiological complete response (CR) when ICT was administered before CCRT [4]; Eur J Nucl Med Mol Imaging (2018) 45:170–178 this suggests that ICT may promote organ preservation and help to avoid surgery, which is associated with high morbidity

Summary

Methods

Tumor responses were retrospectively reviewed after CCRT based on the Response Evaluation Criteria in Solid Tumors. FDG PET-CT imaging was performed before and after three cycles of TPF. We examined the associations between the metabolic response

Conclusions

Introduction

Materials and methods

Results

Discussion

Compliance with ethical standards