Clin Exp Otorhinolaryngol.  2020 Nov;13(4):407-414. 10.21053/ceo.2019.01298.

Pretreatment Photopenia on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scans Predicts Poor Prognosis in Nasopharyngeal Cancer Patients Undergoing Concurrent Chemoradiotherapy

Affiliations
  • 1Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey
  • 2Department of Radiation Oncology, Koc University School of Medicine, Istanbul, Turkey
  • 3Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  • 4Department of Medical Oncology, Baskent University Medical Faculty, Adana, Turkey
  • 5Clinics of Radiation Oncology, Mersin City Hospital, Mersin, Turkey
  • 6Department of Nuclear Medicine, Baskent University Medical Faculty, Adana, Turkey

Abstract


Objectives
. To investigate the influence of pretreatment primary tumor or nodal photopenia (PP) on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT), an indicator of tumor ischemia, on survival results of nasopharyngeal cancers (NPCs) treated with concurrent chemoradiotherapy (C-CRT).
Methods
. The pre-C-CRT FDG PET-CT scans of 104 patients with NPC (cT1-4 N0-3 M0) were retrospectively examined to determine the presence of PP (PP+). Our primary endpoint was the influence of PP+ on overall survival (OS), while the progression-free survival (PFS) and locoregional PFS (LRPFS) constituted the secondary endpoints.
Results
. The PP+ was detected in 29 (27.9%): nine (8.7%), seven (6.7%), and 13 (12.5%) in the primary tumor alone, primary tumor plus neck nodes, and neck nodes alone, respectively. Because the PP+ cases were small by count per location, all comparative analyses were performed according to overall PP+/ PP– status instead of per detected site. At a median follow-up of 67.8 months (range, 9 to 130 months), the median survival times were not reached (NR) for the entire population, while 5-year OS, LRPFS, and PFS rates were 73.3%, 68.2%, and 63.4%, respectively. Comparatively the PP+ patients exhibited significantly poorer median OS (49.8 months vs. NR, P<0.001), LRPFS (40.7 months vs. NR, P=0.001), and PFS (31.8 months vs. NR, P=0.002) durations than their PP– counterparts. Furthermore, the PP+ retained its independent prognostic significance in multivariate analysis (P<0.001).
Conclusion
. Present results uncovered the pre-C-CRT PP as an independent predictor of poor prognosis for NPC patients, which underscore the requirement for the fortification of the local and systemic treatments in hypoxic NPCs.

Keyword

Nasopharyngeal Neoplasms; Concurrent Chemoradiotherapy; Photopenia; FDG-PET-CT; Prognosis

Figure

  • Fig. 1. Demonstration of photopenia on fluorodeoxyglucose positron emission tomography-computed tomography scans. (A) Primary tumor (arrow). (B) Neck node (arrow).

  • Fig. 2. Kaplan-Meier survival estimates according to photopenia (PP) status. (A) Overall survival. (B) Locoregional progression-free survival. (C) Progression-free survival.


Reference

1. Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003; Feb. 21(4):631–7.
Article
2. Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, et al. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol. 2002; Apr. 20(8):2038–44.
Article
3. Lydiatt WM, Patel SG, O’Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, et al. Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; Mar. 67(2):122–37.
Article
4. Li J, Chen S, Peng S, Liu Y, Xing S, He X, et al. Prognostic nomogram for patients with nasopharyngeal carcinoma incorporating hematological biomarkers and clinical characteristics. Int J Biol Sci. 2018; Apr. 14(5):549–56.
Article
5. Topkan E, Ekici NY, Ozdemir Y, Besen AA, Yildirim BA, Mertsoylu H, et al. Baseline hemoglobin <11.0 g/dL has stronger prognostic value than anemia status in nasopharynx cancers treated with chemoradiotherapy. Int J Biol Markers. 2019; Jun. 34(2):139–47.
6. Chung MK, Jeong HS, Park SG, Jang JY, Son YI, Choi JY, et al. Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res. 2009; Sep. 15(18):5861–8.
7. Paidpally V, Chirindel A, Chung CH, Richmon J, Koch W, Quon H, et al. FDG volumetric parameters and survival outcomes after definitive chemoradiotherapy in patients with recurrent head and neck squamous cell carcinoma. AJR Am J Roentgenol. 2014; Aug. 203(2):W139–45.
Article
8. Nakamura K, Joja I, Kodama J, Hongo A, Hiramatsu Y. Measurement of SUVmax plus ADCmin of the primary tumour is a predictor of prognosis in patients with cervical cancer. Eur J Nucl Med Mol Imaging. 2012; Feb. 39(2):283–90.
9. Castelli J, Depeursinge A, de Bari B, Devillers A, de Crevoisier R, Bourhis J, et al. Metabolic tumor volume and total lesion glycolysis in oropharyngeal cancer treated with definitive radiotherapy: which threshold is the best predictor of local control. Clin Nucl Med. 2017; Jun. 42(6):e281–5.
10. Choi WR, Oh JS, Roh JL, Kim JS, Oh I, Choi SH, et al. Metabolic tumor volume and total lesion glycolysis predict tumor progression and survival after salvage surgery for recurrent oral cavity squamous cell carcinoma. Head Neck. 2019; Jun. 41(6):1846–53.
Article
11. Ashley Cox R, Akhurst T, Bressel M, MacManus M, Ball D. Survival and central photopenia detected by fluorine-18 fluoro-deoxy-glucose positron emission tomography (FDG-PET) in patients with locoregional non-small cell lung cancer treated with radiotherapy. Radiother Oncol. 2017; Jul. 124(1):25–30.
Article
12. Xie W, Liu L, He H, Yang K. Prognostic value of hypoxia-inducible factor-1 alpha in nasopharyngeal carcinoma: a meta-analysis. Int J Biol Markers. 2018; Nov. 33(4):447–54.
Article
13. Yip C, Cook GJ, Wee J, Fong KW, Tan T, Goh V. Clinical significance of hypoxia in nasopharyngeal carcinoma with a focus on existing and novel hypoxia molecular imaging. Chin Clin Oncol. 2016; Apr. 5(2):24.
Article
14. Hong B, Lui VW, Hashiguchi M, Hui EP, Chan AT. Targeting tumor hypoxia in nasopharyngeal carcinoma. Head Neck. 2013; Jan. 35(1):133–45.
Article
15. Bredell MG, Ernst J, El-Kochairi I, Dahlem Y, Ikenberg K, Schumann DM. Current relevance of hypoxia in head and neck cancer. Onco target. 2016; Aug. 7(31):50781–804.
Article
16. Al-Zoughbi W, Huang J, Paramasivan GS, Till H, Pichler M, GuertlLackner B, et al. Tumor macroenvironment and metabolism. Semin Oncol. 2014; Apr. 41(2):281–95.
17. Horsman MR, Mortensen LS, Petersen JB, Busk M, Overgaard J. Imaging hypoxia to improve radiotherapy outcome. Nat Rev Clin Oncol. 2012; Dec. 9(12):674–87.
Article
18. Lin YC, Chen SW, Hsieh TC, Yen KY, Yang SN, Wang YC, et al. Risk stratification of metastatic neck nodes by CT and PET in patients with head and neck cancer receiving definitive radiotherapy. J Nucl Med. 2015; Feb. 56(2):183–9.
Article
19. Koukourakis MI, Bentzen SM, Giatromanolaki A, Wilson GD, Daley FM, Saunders MI, et al. Endogenous markers of two separate hypoxia response pathways (hypoxia inducible factor 2 alpha and carbonic anhydrase 9) are associated with radiotherapy failure in head and neck cancer patients recruited in the CHART randomized trial. J Clin Oncol. 2006; Feb. 24(5):727–35.
Article
20. Rademakers SE, Lok J, van der Kogel AJ, Bussink J, Kaanders JH. Metabolic markers in relation to hypoxia; staining patterns and colocalization of pimonidazole, HIF-1α, CAIX, LDH-5, GLUT-1, MCT1 and MCT4. BMC Cancer. 2011; May. 11:167.
Article
21. Lan M, Huang Y, Chen CY, Han F, Wu SX, Tian L, et al. Prognostic value of cervical nodal necrosis in nasopharyngeal carcinoma: analysis of 1800 patients with positive cervical nodal metastasis at MR imaging. Radiology. 2015; Aug. 276(2):536–44.
Article
22. Tang L, Li L, Mao Y, Liu L, Liang S, Chen Y, et al. Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma detected by magnetic resonance imaging: prognostic value and staging categories. Cancer. 2008; Jul. 113(2):347–54.
23. Zhang LL, Li JX, Zhou GQ, Tang LL, Ma J, Lin AH, et al. Influence of cervical node necrosis of different grades on the prognosis of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. J Cancer. 2017; Mar. 8(6):959–66.
Article
24. Nordsmark M, Overgaard J. Tumor hypoxia is independent of hemoglobin and prognostic for loco-regional tumor control after primary radiotherapy in advanced head and neck cancer. Acta Oncol. 2004; 43(4):396–403.
Article
25. Lee AW, Ng WT, Chan LL, Hung WM, Chan CC, Sze HC, et al. Evolution of treatment for nasopharyngeal cancer: success and setback in the intensity-modulated radiotherapy era. Radiother Oncol. 2014; Mar. 110(3):377–84.
26. Hong B, Lui VW, Hui EP, Ng MH, Cheng SH, Sung FL, et al. Hypoxia-targeting by tirapazamine (TPZ) induces preferential growth inhibition of nasopharyngeal carcinoma cells with Chk1/2 activation. Invest New Drugs. 2011; Jun. 29(3):401–10.
Article
27. Erler JT, Bennewith KL, Nicolau M, Dornhofer N, Kong C, Le QT, et al. Lysyl oxidase is essential for hypoxia-induced metastasis. Nature. 2006; Apr. 440(7088):1222–6.
Article
28. Xueguan L, Xiaoshen W, Yongsheng Z, Chaosu H, Chunying S, Yan F. Hypoxia inducible factor-1 alpha and vascular endothelial growth factor expression are associated with a poor prognosis in patients with nasopharyngeal carcinoma receiving radiotherapy with carbogen and nicotinamide. Clin Oncol (R Coll Radiol). 2008; Oct. 20(8):606–12.
Full Text Links
  • CEO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr