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

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FIGURE 1.
Treatment and imaging protocol.
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FIGURE 2.
ROC curves for SUVmean (A) and SUVmax (B). Areas under curves are 0.883 (A) and 0.857 (B).
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FIGURE 3.
(A and B) Patient 13, with left hypopharynx cancer. ¹¹C-Methionine PET scans before (A) and after (B) first course of chemotherapy show complete response after treatment completion, with 99% decrease in MRI volume. (C and D) Patient 3, with left hypopharynx cancer and left cervical metastatic lymph node. ¹¹C-Methionine PET scans before (C) and after (D) first course of chemotherapy show progressive disease after treatment completion, with 23% increase in MRI volume. Note intense physiologic uptake in salivary glands.

TABLE 1

PET Parameters and MRI Measurements

Patient no.	MRI volume (cm³)			SUVmean			SUVmax			PET volume (cm³)
Patient no.		I	RD	I	RD	I	RD	I	RD	I	RD
1	6.0	+7	4.9	−2	5.9	+17	6.3	−62	30.9	−62
2	31.7	−90	6.8	−39	14.6	−66	35.0	−97	239.0	−98
3	11.0	+28	3.6	+3	5.7	+19	12.5	+13	44.7	+15
4	6.8	−39	4.2	−26	6.3	−40	4.7	−48	20.2	−61
5	8.3	−55	5.5	−7	10.6	−4	11.4	−38	63.3	−42
6	20.0	−100	4.7	−31	9.9	−53	27.8	−81	130.0	−87
7	10.9	−63	2.5	−16	3.8	−30	9.4	−75	23.2	−78
8	4.7	−26	2.8	−5	3.9	−24	4.1	−41	11.4	−47
9	9.4	+21	6.9	−6	9.4	−13	11.4	−80	79.0	−81
10	32.9	−56	4.3	−5	7.4	−38	26.9	−97	116.0	−97
11	11.1	−44	4.7	−6	6.4	−8	9.0	−75	42.1	−77
12	10.2	−31	3.6	−3	5.6	+9	10.9	−38	39.2	−22
13	23.7	−99	6.2	−31	11.1	−46	15.1	−93	93.6	−95

I = initial measurements on first examination, MRI or PET; RD = relative decrease on second examination, MRI or PET, in % = ([2 − 1]/1) × 100.

TABLE 2

Clinical Outcome and PET Response According to SUVmean and SUVmax Optimal Thresholds

Patient no.	Stage	Adjuvant surgery	Follow-up (mo)	Death	Response, SUVmean threshold −6%	Response, SUVmax threshold −25%
1	T4 N3 M0	−	9	+	−	−
2	T3 N0 M0	−	40	−	+	+
3	T3 N1 M0	−	7	+	−	−
4	T4 N3 M0	−	3	+	+	+
5	T3 N2 M0	−	27	+	+	−
6	T4 N2 M0	−	26	−	+	+
7	T4 N2 M0	−	20	−	+	+
8	T3 N2 M0	−	20	−	−	−
9	T3 N3 M0	+	17	−	−	−
10	T4 N3 M0	+	17	−	−	+
11	T4 N2 M0	−	16	−	−	−
12	T3 N0 M0	−	8	+	−	−
13	T4 N0 M0	−	14	−	+	+