Radiat Oncol J.  2011 Dec;29(4):243-251. 10.3857/roj.2011.29.4.243.

FDG-PET/CT as prognostic factor and surveillance tool for postoperative radiation recurrence in locally advanced head and neck cancer

• Kim G
• Kim YS
• Han EJ
• Yoo IR
• Song JH
• Lee SN
• Lee JH
• Choi BO
• Jang HS
• Yoon SC

• KMID: 1842021
• DOI: http://doi.org/10.3857/roj.2011.29.4.243

Abstract

PURPOSE
To evaluate the prognostic value of metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) on initial positron emission tomography-computed tomography (PET-CT) and investigate the clinical value of SUVmax for early detection of locoregional recurrent disease after postoperative radiotherapy in patients with locally advanced head and neck squamous cell carcinoma (HNSCC).
MATERIALS AND METHODS
A total of 100 patients with locally advanced HNSCC received primary tumor excision and neck dissection followed by adjuvant radiotherapy with or without chemotherapy. The MTV and SUVmax were measured from primary sites and neck nodes. The prognostic value of MTV and SUVmax were assessed using initial staging PET/CT (study A). Follow-up PET/CT scan available after postoperative concurrent chemoradiotherapy or radiotherapy were evaluated for the SUVmax value and correlated with locoregional recurrence (study B). A receiver operating characteristic (ROC) curve analysis was used to define a threshold value of SUVmax with the highest accuracy for recurrent disease assessment.
RESULTS
High MTV (>41 mL) is negative prognostic factor for disease free survival (p = 0.041). Postradiation SUVmax was significantly correlated with locoregional recurrence (hazard ratio, 1.812; 95% confidence interval, 1.361 to 2.413; p < 0.001). A cut-off value of 5.38 from follow-up PET/CT was identified as having maximal accuracy for detecting locoregional recurrence by ROC analysis.
CONCLUSION
MTV at staging work-up was significantly associated with disease free survival. The SUVmax value from follow-up PET/CT showed high diagnostic accuracy for the detection of locoregional recurrence in postoperatively irradiated HNSCC.

Keyword

Head and neck squamous cell carcinoma; Metabolic tumor volume; Positron-emission tomography; Postoperative radiation therapy; Locoregional recurrence

MeSH Terms

Carcinoma, Squamous Cell
Chemoradiotherapy
Disease-Free Survival
Electrons
Follow-Up Studies
Head
Head and Neck Neoplasms
Humans
Neck
Neck Dissection
Positron-Emission Tomography
Radiotherapy, Adjuvant
Recurrence
ROC Curve
Tumor Burden