Interim FDG PET/CT for Predicting the Outcome in Patients with Head and Neck Cancer

Objectives/HypothesisThe study aimed to investigate the prognostic effects of interim (18)fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (PET/CT) during definitive radiotherapy (RT) or chemoradiotherapy (CRT) in patients with head and neck cancer. Study DesignThis is a prospectively treatment study. MethodsThe pretreatment and interim PET/CT images of 51 patients with advanced pharyngeal cancers receiving definitive RT/CRT were evaluated prospectively. The interim PET/CT images were taken at a cumulative RT dose ranging from 41.4 to 46.8 Gy. The maximum standardized uptake value (SUVm) of the interim PET/CT and the reduction ratio of the SUVm (SRR) between the two images were measured. The differences between patients with or without local failures were examined using the Mann-Whitney test. Overall survival (OS), disease-free survival (DFS), and primary and nodal relapse-free survival rates were calculated using the Kaplan-Meier method. Independent prognosticators were identified using Cox regression analysis. ResultsAfter a median follow-up duration of 23 months, a higher interim SUVm was associated with local failures. Conducting a multivariate analysis revealed that a SUVmax reduction ratio of primary tumor (SRR-P)<0.64 was associated with the inferior OS (hazard ratio 2.64; P =0.035) and DFS (hazard ratio 2.33; P=0.045). Patients who had tumors with an SRR-P<0.64 had a considerably lower 2-year OS and DFS compared with those who had SRR-P0.64 (47% vs. 66%; 41% vs. 64%). ConclusionA higher interim SUVm was associated with local recurrence. In addition, patients with a lower SRR-P should be considered to be at risk of primary failure. Level of Evidence4. Laryngoscope, 124:2732-2738, 2014