Prognostic significance of metabolic tumour volume and maximum standard uptake value of fluor-18-fluorodeoxyglucose positron emission tomography with computed tomography in nasopharyngeal carcinoma

Christopher John; Jeyaanth Venkatasai; Satish Srinivas Kondaveeti; Arunan Murali; Gokulakrishnan Periakaruppan; Venkatachalapathy E; Manickavasagam Meenakshisundaram; Ravi Chandran Ambalathandi; Hemavathi Masilamani

doi:10.5114/wo.2021.109620

Prognostic significance of metabolic tumour volume and maximum standard uptake value of fluor-18-fluorodeoxyglucose positron emission tomography with computed tomography in nasopharyngeal carcinoma

Contemp Oncol (Pozn). 2021;25(3):153-159. doi: 10.5114/wo.2021.109620. Epub 2021 Oct 1.

Authors

Christopher John¹, Jeyaanth Venkatasai¹, Satish Srinivas Kondaveeti¹, Arunan Murali², Gokulakrishnan Periakaruppan², Venkatachalapathy E³, Manickavasagam Meenakshisundaram⁴, Ravi Chandran Ambalathandi⁴, Hemavathi Masilamani¹

Affiliations

¹ Department of Radiation Oncology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.
² Department of Radio-Diagnosis, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.
³ Department of Nuclear Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.
⁴ Department of Medical Oncology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.

Abstract

Aim of the study: To evaluate the prognostic role of markers of fluor-18-fluorodeoxyglucose positron emission tomography with computed tomography (¹⁸F-FDG-PET-CT), such as maximum standard uptake value (SUV_max) and metabolic tumour volume (MTV) measured at primary and nodal disease, and their clinical significance in terms of predicting treatment outcomes and survival.

Material and methods: Between January 2017 and January 2020, 20 case records of nasopharyngeal carcinoma patients who underwent ¹⁸F-FDG-PET-CT as part of staging workup before radiotherapy and as a part of response evaluation after radiotherapy were retrospectively reviewed.

Results: At a median follow-up of 34.7 months, the 2-year progression-free survival (PFS) was 70% and 2-year overall survival (OS) was 79%. Patients with a lower nodal SUV_max (SUV_max-N) had a better 2-year PFS (91% vs. 46%; p = 0.035) and 2-year OS (95% vs. 58%; p = 0.015). A high SUV_max-N of > 10.58 was a negative predictor of OS (95% confidence interval [CI]: 0.93-1; p = 0.003) as well as PFS (95% CI: 0.64-1; p = 0.017). Also, a high MTV > 25.8 cm³ was a negative predictor of PFS (95% CI: 0.58-0.98; p = 0.048). MTV was an independent predictor of PFS and OS on univariate analysis, whereas it was not significant in the Cox regression multivariate analysis.

Conclusions: High values of MTV and SUV_max-N can be considered as independent prognostic factors of OS and PFS in nasopharyngeal cancer patients treated with concurrent chemoradiation, highlighting the need for more intensified treatment.

Keywords: MTV; SUVmax; nasopharyngeal carcinoma; prognostic factor.