Utility and limitations of metabolic parameters in head and neck cancer: finding a practical segmentation method (original) (raw)
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Head & Neck
BackgroundValidated biomarkers in head and neck squamous cell carcinoma (HNSCC) are scarce.MethodsWe retrospectively analyzed 62 patients with HNSCC treated with radiotherapy +/− concurrent chemotherapy. Pretreatment metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured in a 18F‐FDG positron emission tomography using a liver dependent standardized uptake value threshold. Cox regression analyses were performed to find associations with disease‐free survival (DFS) and overall survival (OS).ResultsHigh values of MTV (>37 ml) were independently associated with a worse DFS (hazard ratio [HR] = 3.45; 95% confidence interval [CI], 1.52–7.84) and OS (HR = 3.27; 95% CI, 1.41–7.57). Similar results were found for high values of TLG (>247 g) for DFS (HR = 3.32; 95% CI, 1.44–7.65) and OS (HR = 3.42; 95% CI, 1.45–8.07).ConclusionsMTV and TLG can be considered as independent prognostic factors for DFS and OS in patients with HNSCC. Considering how easily obtainable th...
Validation that Metabolic Tumor Volume Predicts Outcome in Head and Neck Cancer
International Journal of Radiation Oncology*Biology*Physics, 2011
Purpose-We have previously reported that metabolic tumor volume (MTV) obtained from pretreatment FDG PET/CT predicted outcome in patients with head-and-neck cancer (HNC). The purpose of this study is to validate these results on an independent dataset, determine if the primary tumor or nodal MTV drives this correlation, and explore the interaction with p16 INK4a status as a surrogate marker for HPV. Methods and Materials-The validation dataset in this study included 83 patients with squamous cell HNC who had a FDG PET/CT scan prior to definitive radiotherapy. MTV and SUV max were calculated for the primary tumor, involved nodes, and the combination of both. The primary endpoint was to validate that MTV predicted progression-free survival and overall survival. Secondary analyses included determining the prognostic utility of primary tumor versus nodal MTV. Results-Similar to our prior findings, an increase in total MTV of 17 cm 3 (difference between 75 th and 25 th percentile) was associated with a 2.1 fold increase in the risk of disease progression (p=0.0002), and a 2.0 fold increase in the risk of death (p=0.0048). SUV max was not associated with either outcome. Primary tumor MTV predicted progression-free (HR=1.94; p<0.0001) and overall (HR=1.57; p<0.0001) survival, whereas nodal MTV did not. In addition, MTV predicted progression-free (HR=4.23; p<0.0001) and overall (HR=3.21; p=0.0029) survival in patients with p16 INK4a positive oropharyngeal cancer. Conclusions-This study validates our previous findings that MTV independently predicts outcomes in HNC. MTV should be considered as a potential risk stratifying biomarker in future studies of HNC.
Metabolic Tumor Volume Predicts for Recurrence and Death in Head-and-Neck Cancer
International Journal of Radiation Oncology Biology Physics, 2009
Purpose-To evaluate the prognostic value of metabolic tumor volume measured on 18Ffluorodeoxyglucose positron emission tomography (FDG-PET) imaging and other clinical factors in patients treated for locally advanced head and neck cancer at a single institution. 85 patients received PET/CT-guided chemoradiotherapy for HNC. Metabolically active tumor regions were delineated on pretreatment PET scans semi-automatically using custom software. We evaluated the relationship of FDG-PET maximum standardized uptake value (SUV) and total metabolic tumor volume (MTV) with diseasefree survival (DFS) and overall survival (OS).
Postradiation Metabolic Tumor Volume Predicts Outcome in Head-and-Neck Cancer
International Journal of Radiation Oncology Biology Physics, 2011
Purpose: To explore the prognostic value of metabolic tumor volume measured on postradiation ¹F-fluorodeoxyglucose positron emission tomography (PET) imaging in patients with head-and-neck cancer. Methods and Materials: Forty-seven patients with head-and-neck cancer who received pretreatment and posttreatment PET/computed tomography (CT) imaging along with definitive chemoradiotherapy were included in this study. The PET/CT parameters evaluated include the maximum standardized uptake value,
Erciyes Medical Journal, 2020
Objective: Conventional prognostic factors are not yet sufficient to predict treatment outcomes factors in nasopharyngeal carcinoma (NPC). Parameters from PET/CT are still being investigated as a prognostic factor in nasopharyngeal cancer. Materials and Methods: We retrospectively analyzed total lesion glycolysis (TLG), metabolic tumor volume (MTV), and maximum standardized uptake value (SUVmax) in patients with non-metastatic nasopharyngeal cancer treated with intensity adjusted radiotherapy. According to the ROC analysis, we divided the whole cohort into two groups. Kaplan-Meier tests were used to evaluate survival differences between groups. Univariate and multivariate analyzes were performed to find the factors affecting the prognosis. P<0.05 was accepted as statistically significant. Results: Ninety-one non-metastatic nasopharyngeal cancer patients were enrolled in this study. According to cutoff values, both MTVtumor and TLGnode were found as an independent prognostic factor for overall survival (OS). High MTVtumor (>21.5) and high TLGnode (>186.7) correlated with 4.9 and 4-fold increased mortality risk, respectively. Multivariate analyses showed high MTVtotal (>59.5) was associated with a 3.3 fold increased risk of locoregional recurrence. High TLGtotal (>181.56) was found to be independent prognostic factor for distant metastasis-free survival and it was associated with a 5.4 fold increased risk. The 5-years OS rate was 58.5% in high MTVtotal (>59.5) patients and 82.4% in low MTVtotal (<59.5) patients (p<0.01). The 5-years OS rates were 64.2% in patients with high TLGtotal (>181) and 88% in patients with low TLGtotal (p<0.01). Conclusion: The results of our study showed that MTVtumor and TLGnode values are significant independent prognostic factors for OS.
Journal of Nuclear Medicine, 2012
Treatment of oropharyngeal squamous cell carcinoma with chemoradiotherapy can now accomplish excellent locoregional disease control, but patient overall survival (OS) remains limited by development of distant metastases (DM). We investigated the prognostic value of staging 18 F-FDG PET/CT, beyond clinical risk factors, for predicting DM and OS in 176 patients after definitive chemoradiotherapy. Methods: The PET parameters maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were recorded. Univariate Cox regression was used to examine the prognostic value of these variables and clinical prognosticators for local treatment failure (LTF), OS, and DM. Multivariate analysis examined the effect of SUVmax, TLG, and MTV in the presence of other covariates. Kaplan-Meier curves were used to evaluate prognostic values of PET/CT parameters. Results: Primary tumors were distributed across all stages. Most patients underwent chemoradiotherapy only, and 11 also underwent tonsillectomy. On univariate analysis, primary tumor MTV was predictive of LTF (P 5 0.005, hazard ratio [HR] 5 2.4 for a doubling of MTV), DM and OS (P , 0.001 for both, HR 5 1.9 and 1.8, respectively). The primary tumor TLG was associated with DM and OS (P , 0.001, HR 5 1.6 and 1.7, respectively, for a doubling of TLG). The primary tumor SUVmax was associated with death (P 5 0.029, HR 5 1.1 for a 1-unit increase in standardized uptake value) but had no relationship with LTF or DM. In multivariate analysis, TLG and MTV remained associated with death after correcting for T stage (P 5 0.0125 and 0.0324, respectively) whereas no relationship was seen between standardized uptake value and death after adjusting for T stage (P 5 0.158). Conclusion: Parameters capturing the volume of 18 F-FDG-positive disease (MTV or TLG) provide important prognostic information in oropharyngeal squamous cell carcinoma treated with chemoradiotherapy and should be considered for risk stratification in this disease.
Journal of Nuclear Medicine, 2012
18 F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). Methods: The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant singleinstitution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38%, 50%, and 60% of maximum standardized uptake value (SUV). The TGA is defined as MTV · mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. Results: In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95% confidence interval, 1.01-1.10; P 5 0.006) and 1.00 (95% confidence interval, 1.00-1.01; P 5 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (x 2 value change, 1.16-6.71; P 5 0.01) and when TGA was added to AJCC stage in model II (x 2 value change, 1.16-4.37; P 5 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P 5 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P 5 0.08), though the result was not statistically significant. Conclusion: Gradient-based segmentations of primary tumor MTV and TGA are potential 18 F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.