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Early Response to Chemotherapy in Hypopharyngeal Cancer: Assessment with ¹¹C-Methionine PET, Correlation with Morphologic Response, and Clinical Outcome

¹ Department of Nuclear Medicine, University Hospital, Caen, France
² Department of Head and Neck Surgery, University Hospital, Caen, France
³ Department of Radiology, University Hospital, Caen, France
⁴ Department of Medical Informatics and Epidemiology, University Hospital, Caen, France
⁵ Cyceron PET Center, Commissariat à l’Energie Atomique/Direction des Sciences du Vivant, Caen, France
⁶ Laboratory of Anatomy, University Hospital, Caen, France

Neoadjuvant chemotherapy in hypopharyngeal cancer globally improves survival, but some patients do not respond to chemotherapy and adjuvant therapy is delayed. Prediction of response to chemotherapy may allow physicians to optimize planned treatment. The aim of this study was to compare treatment response assessed early with ¹¹C-methionine PET and morphologic response assessed after treatment completion with MRI. Methods: Thirteen patients with previously untreated squamous cell carcinoma of the hypopharynx, T3 or T4, were included. All patients received 3 courses of chemotherapy comprising cisplatin and 5-fluorouracil. ¹¹C-Methionine PET was performed before and after the first course of chemotherapy. PET estimation of response was expressed in relative variation of mean standardized uptake value (SUVmean), maximal standardized uptake value (SUVmax), volume of ¹¹C-methionine tumor uptake, and total tumor uptake. Posttreatment response was assessed with MRI, which was performed before the first course and after treatment completion, and expressed in relative variation of tumor volume. Patients were considered responders if their tumor volume was reduced by more than 50%. Results: The relative decrease in all PET parameters correlated significantly with the relative decrease in MRI volume. The larger area under the receiver operating characteristic curve was obtained for SUVmean (0.883), but that area was close to the area of SUVmax (0.857). For methodologic considerations, SUVmax was more reproducible. The optimal threshold of response for SUVmax was -25%, leading to a mean of 83% (range, 36%–93%) sensitivity and 86% (range, 42%–100%) specificity. Using this threshold, survival at 2 y was improved for responders (83%), compared with nonresponders (57%), but the difference was not statistically significant. Conclusion: ¹¹C-Methionine PET provides early useful information about changes in tumor metabolism induced by chemotherapy in hypopharynx cancer. ¹¹C-Methionine PET measurements correlate with end-of-treatment response evaluated with MRI and may thus be helpful to physicians in treatment planning by avoiding unnecessary chemotherapy courses for nonresponding patients.

Key Words: PET • ¹¹C-methionine • chemotherapy monitoring • hypopharyngeal cancer