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Use of ¹⁸F-FDG PET for Primary Treatment Strategy in Patients with Squamous Cell Carcinoma of the Oropharynx

¹ Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; ² Department of Otolaryngology, Bundang Jaesaeng General Hospital, Sungnam, South Korea; ³ Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; ⁴ Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and ⁵ Department of Internal Medicine (Medical Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Correspondence: For correspondence or reprints contact: Jong-Lyel Roh, MD, PhD, Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea. E-mail: rohjl{at}amc.seoul.kr

High tumor uptake of ¹⁸F-FDG is associated with an unfavorable outcome in cancer patients. We evaluated pretreatment ¹⁸F-FDG uptake as guidance for the primary treatment modality in patients with squamous cell carcinoma (SCC) of the oropharynx. Methods: Fifty-two consecutive patients with newly diagnosed resectable SCC of the oropharynx underwent ¹⁸F-FDG PET before treatment. Primary treatment modalities consisted of surgical resection plus radiotherapy (RT) (surgery group, n = 31) or radical RT plus chemotherapy (RT group, n = 21). The sex, age, tumor stage, histologic grade, TNM classification, treatment strategy, and maximum standardized uptake value (SUV) categories were analyzed for association with local control (LC) and disease-free survival (DFS). The median follow-up of the surviving patients was 36 mo. Results: The median SUV was significantly higher in the 11 patients who failed treatment than that in the remaining controlled patients (8.0 vs. 5.4; P = 0.021). Patients having tumors with a high SUV > 6.0 had poorer LC and DFS (P < 0.05). In multivariate analysis, the SUV remained an independent determinant of LC and DFS (P < 0.05). Patients with a SUV > 6.0 in the surgery group had a higher 3-y DFS than that in the RT group (78% vs. 33%; P = 0.043). Conclusion: Pretreatment tumor ¹⁸F-FDG uptake represents an independent prognostic factor in patients with oropharyngeal SCC. Patients with high ¹⁸F-FDG uptake may be better treated by surgery followed by RT with or without chemotherapy, which needs to be verified by a prospective randomized study.

Key Words: squamous cell carcinoma • oropharynx • predictive factor • ¹⁸F-FDG PET • standardized uptake value

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