Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck

Viktoras Rudžianskas; Erika Korobeinikova; Milda Rudžianskienė; Evelina Jaselskė; Diana Adlienė; Severina Šedienė; Ilona Kulakienė; Evaldas Padervinskis; Nemira Jurkienė; Elona Juozaitytė

doi:10.3390/medicina54060107

Use of ¹⁸F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck

Medicina (Kaunas). 2018 Dec 10;54(6):107. doi: 10.3390/medicina54060107.

Affiliations

¹ Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. viktoras.rudzianskas@lsmuni.lt.
² Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. erika.korobeinikova@lsmuni.lt.
³ Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. milda.rudzianskiene@lsmuni.lt.
⁴ Faculty of Mathematics and Natural Sciences, Department of Physics, Kaunas University of Technology, Studentų g. 50, 51368 Kaunas, Lithuania. evelina.jaselske@ktu.edu.
⁵ Faculty of Mathematics and Natural Sciences, Department of Physics, Kaunas University of Technology, Studentų g. 50, 51368 Kaunas, Lithuania. diana.adliene@ktu.lt.
⁶ Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. severina.sediene@lsmuni.lt.
⁷ Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. kulakiene@dr.com.
⁸ Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. evaldas.padervinskis@lsmuni.lt.
⁹ Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. nemira.jurkiene@lsmuni.lt.
¹⁰ Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania. elona.juozaityte@lsmuni.lt.

Abstract

Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As ¹⁸F-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of ¹⁸F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUV_max), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUV_max, MTV and TLG in primary tumor and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progress was localized in high-to-intermediate dose (60⁻70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUV_max ≥ 74% (p = 0.04), MTV ≥ 68% (p = 0.03), TLG ≥ 76% (p = 0.03) in primary tumor, and LN TLG decrease ≥ 74% (p = 0.03) were associated with PFS. Decrease of primary tumor SUV_max ≥ 74% (p = 0.04), MTV ≥ 69% (p = 0.03), TLG ≥ 74% (p = 0.02) and LN TLG ≥ 73% (p = 0.02) were prognostic factors for OS. Conclusions: According to our results, ¹⁸F-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impacts on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUV_max, MTV and TLG has a prognostic value in LA-SCCHN.

Keywords: 18F-FDG PET/CT; head and neck cancer; induction chemotherapy; target volume delineation.

MeSH terms

Adult
Aged
Cohort Studies
Disease Progression
Female
Fluorodeoxyglucose F18 / pharmacokinetics
Glycolysis
Head and Neck Neoplasms / diagnostic imaging*
Head and Neck Neoplasms / drug therapy*
Head and Neck Neoplasms / radiotherapy
Humans
Induction Chemotherapy*
Male
Middle Aged
Positron Emission Tomography Computed Tomography*
Prognosis
Prospective Studies
Radiopharmaceuticals / pharmacokinetics
Radiotherapy
Regression Analysis
Squamous Cell Carcinoma of Head and Neck / diagnostic imaging*
Squamous Cell Carcinoma of Head and Neck / drug therapy*
Squamous Cell Carcinoma of Head and Neck / radiotherapy
Tumor Burden

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18