Abstract
To investigate the prognostic impact of computed tomogram (CT) and 18Fluoro-deoxyglucose PET/CT on the outcome of metastatic neck node (MNN) in patients with head and neck cancer receiving definitive radiotherapy (RT) or chemoradiotherapy (CRT). Methods: This patient-based study included 91 patients diagnosed with pharyngeal cancers with MNN (N1: 15, N2: 70, N3: 6). All had pretreatment CT and PET/CT before definitive CRT/RT. Parameters of MNNs for each patient, including maximal diameter, nodal volume, radiological central necrosis, maximum standardized uptake, metabolic tumor volume, and total lesion glycolysis (TLG) were retrieved for the analysis. Nodal relapse-free survival (NRFS) and survivals were calculated using the Kaplan-Meier method. Independent predictors were identified using Cox regression analysis. Results: After a median follow-up of 18 months, 64 patients remained nodal relapse-free, and 27 experienced neck recurrence. Multivariate analysis showed that the application of 40% of the maximal uptake of nodal TLG (N-TLG40%) ≧ 38 g [P = 0.03, Hazard ratio (HR) 2.63, 95 % Confidence interval (CI) 1.10 ~ 6.30] and radiological necrosis on CT scan (P = 0.001, HR 10.99, 95% CI 2.56 ~ 47.62) were two adverse features for NRFS. Patients who had a N-TLG40% ≧ 38 g and central radiological necrosis had significantly inferior 2-year NRFS (53% vs. 77% and 45% vs. 95%, respectively). Conclusion: The outcome of MNNs in patients with head and neck cancer receiving CRT/RT can be predicted according to radiological necrosis and N-TLG40% value. The two adverse features should be validated in future trials. By this way, patients can be treated alternatively or aggressively.
- Oncology: Head and neck
- PET/CT
- 18Fluoro-deoxyglucose PET/CT
- computed tomogram
- head and neck cancer
- metastatic neck lymph node
- radiotherapy
- Copyright © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.