Abstract
PurposeEvidence is conflicting on the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of our study was to determine the impact of semiquantitative and qualitative metabolic parameters on the outcome in patients managed with standard treatment for locally advanced disease.MethodsA systematic review of the literature was conducted. A meta-analysis was performed of studies providing estimates of relative risk (RR) for the association between semiquantitative metabolic parameters and efficacy outcome measures.ResultsThe analysis included 25 studies, for a total of 2,223 subjects. The most frequent primary tumour site was the oropharynx (1,150/2,223 patients, 51.7%). According to the available data, the majority of patients had stage III/IV disease (1,709/1,799, 94.9%; no information available in four studies) and were treated with standard concurrent chemoradiotherapy (1,562/2,009 patients, 77.7%; only one study without available information). A total of 11, 8 and 4 independent studies provided RR estimates for the association between baseline FDG PET metrics and overall survival (OS), progression-free survival (PFS) and locoregional control (LRC), respectively. High pretreatment metabolic tumour volume (MTV) was significantly associated with a worse OS (summary RR 1.86, 95% CI 1.08–3.21), PFS (summary RR 1.81, 95% CI 1.14–2.89) and LRC (summary RR 3.49, 95% CI 1.65–7.35). Given the large heterogeneity (I2 > 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUVmax and any of the outcome measures.ConclusionFDG PET has prognostic relevance in the context of locally advanced head and neck squamous cell carcinoma. Pretreatment MTV is the only metabolic variable with a significant impact on patient outcome. Because of the heterogeneity and the lack of standardized methodology, no definitive conclusions on optimal cut-off values can be drawn.
Highlights
Head and neck cancer is the sixth most common malignant tumour, with increasing incidence worldwide [1]
Since the main aim of this review was to investigate the potential impact of specific metabolic data on head and neck squamous cell carcinoma (HNSCC) prognosis, the following parameters were considered as main interventions: standardized uptake values (SUVmax, SUVmean, SUVpeak), metabolic tumour volume (MTV) and total lesion glycolysis (TLG)
Higher MTV values for the primary or primary and nodal disease combined were significantly associated with a worse overall survival (OS) (SRR 1.86, 95% confidence intervals (CI) 1.08–3.21), progression-free survival (PFS) (SRR 1.81, 95% CI 1.14–2.89) and locoregional control (LRC) (SRR 3.49, 95% CI 1.65– 7.35), Instead, we found no statistically significant association between SUVmax and any of OS, PFS and LRC
Summary
Head and neck cancer is the sixth most common malignant tumour, with increasing incidence worldwide [1]. Due to the absence of anatomical barriers, the abundant lymphatic drainage of the neck and the usually infiltrative pattern of growth of head and neck squamous cell carcinoma (HNSCC), in about 60% of patients the diagnosis is made at an advanced locoregional stage. Notwithstanding the refinement of treatment strategies that has taken place in last 20 years, the prognosis of HNSCC remains severe, with a cumulative 5-year overall survival (OS) rate of 45–55% [3] in patients with locally advanced disease. The prevalent pattern of failure in the overall population is locoregional: about 50% of first events of relapse occur at the primary tumour site and/or in the neck, in the vast majority (about 90%) within the first 2 years after treatment
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