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Research ArticleClinical Investigation

18F-FDG PET/CT Prediction of Treatment Outcomes in Human Papillomavirus–Positive, Locally Advanced Oropharyngeal Cancer Patients Receiving Deintensified Therapy: Results from NRG-HN002

Rathan M. Subramaniam, Lyudmila DeMora, Min Yao, Sue S. Yom, Maura Gillison, Jimmy J. Caudell, John Waldron, Ping Xia, Christine H. Chung, Minh Tam Truong, Michelle Echevarria, Jason W. Chan, Jessica L. Geiger, Loren Mell, Samantha Seaward, Wade L. Thorstad, Jonathan Jay Beitler, Khalil Sultanem, Diagjin Blakaj and Quynh-Thu Le
Journal of Nuclear Medicine March 2023, 64 (3) 362-367; DOI: https://doi.org/10.2967/jnumed.122.264424
Rathan M. Subramaniam
1Otago Medical School, University of Otago, Otago, New Zealand;
2Duke University, Durham, North Carolina;
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Lyudmila DeMora
3NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania;
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Min Yao
4University Hospitals Cleveland, Cleveland, Ohio;
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Sue S. Yom
5University of California, San Francisco, California;
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Maura Gillison
6University of Texas MD Anderson Cancer Center, Houston, Texas;
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Jimmy J. Caudell
7Moffitt Cancer Center, Tampa, Florida;
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John Waldron
8Princess Margaret Hospital, Toronto, Oneida, Canada;
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Ping Xia
9Cleveland Clinic, Cleveland, Ohio;
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Christine H. Chung
7Moffitt Cancer Center, Tampa, Florida;
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Minh Tam Truong
10Boston Medical Center, Boston, Massachusetts;
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Michelle Echevarria
7Moffitt Cancer Center, Tampa, Florida;
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Jason W. Chan
5University of California, San Francisco, California;
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Jessica L. Geiger
11Case Western Reserve University, Cleveland, Ohio;
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Loren Mell
12UC San Diego Moores Cancer Center, San Diego, California;
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Samantha Seaward
13Kaiser Permanente NCI Community Oncology Research Program, Vallejo, California;
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Wade L. Thorstad
14Washington University School of Medicine, St. Louis, Missouri;
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Jonathan Jay Beitler
15Emory University/Winship Cancer Institute, Atlanta, Georgia;
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Khalil Sultanem
16Jewish General Hospital, Montreal, Canada;
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Diagjin Blakaj
17Ohio State University Comprehensive Cancer Center, Columbus, Ohio; and
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Quynh-Thu Le
18Stanford University, Stanford, California
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Abstract

The purpose of this study was to determine the negative predictive value (NPV) of a 12- to 14-wk posttreatment PET/CT for 2-y progression-free survival (PFS) and locoregional control (LRC) in patients with p16-positive locoregionally advanced oropharyngeal cancer (LA-OPC). Study was a secondary endpoint in NRG-HN002, a noncomparative phase II trial in p16-positive LA-OPC, stage T1-T2, N1-N2b or T3, N0-N2b, and ≤10 pack-year smoking. Patients were randomized in a 1:1 ratio to reduced-dose intensity-modulated radiotherapy (IMRT) with or without cisplatin. Methods: PET/CT scans were reviewed centrally. Tumor response evaluations for the primary site, right neck, and left neck were performed using a 5-point ordinal scale (Hopkins criteria). Overall scores were then assigned as negative, positive, or indeterminate. Patients with a negative score for all 3 evaluation sites were given an overall score of negative. The hypotheses were NPV for PFS and LRC at 2-y posttreatment ≤ 90% versus >90% (1-sided P value, 0.10). Results: A total of 316 patients were enrolled, of whom 306 were randomized and eligible. Of these, 131 (42.8%) patients consented to a posttherapy PET/CT, and 117 (89.3%) patients were eligible for PET/CT analysis. The median time from the end of treatment to PET/CT scan was 94 d (range, 52–139 d). Estimated 2-y PFS and LRC rates in the analysis subgroup were 91.3% (95% CI, 84.6, 95.8%) and 93.8% (95% CI, 87.6, 97.5%), respectively. Posttreatment scans were negative for residual tumor for 115 patients (98.3%) and positive for 2 patients (1.7%). NPV for 2-y PFS was 92.0% (90% lower confidence bound [LCB] 87.7%; P = 0.30) and for LRC was 94.5% (90% LCB 90.6%; P = 0.07). Conclusion: In the context of deintensification with reduced-dose radiation, the NPV of a 12- to 14-wk posttherapy PET/CT for 2-y LRC is estimated to be >90%, similar to that reported for patients receiving standard chemoradiation. However, there is insufficient evidence to conclude that the NPV is >90% for PFS.

  • PET/CT negative predictive value
  • p16-positive oropharyngeal cancer
  • NRG-HN002

Footnotes

  • Published online Sep. 2, 2022.

  • © 2023 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 64 (3)
Journal of Nuclear Medicine
Vol. 64, Issue 3
March 1, 2023
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18F-FDG PET/CT Prediction of Treatment Outcomes in Human Papillomavirus–Positive, Locally Advanced Oropharyngeal Cancer Patients Receiving Deintensified Therapy: Results from NRG-HN002
Rathan M. Subramaniam, Lyudmila DeMora, Min Yao, Sue S. Yom, Maura Gillison, Jimmy J. Caudell, John Waldron, Ping Xia, Christine H. Chung, Minh Tam Truong, Michelle Echevarria, Jason W. Chan, Jessica L. Geiger, Loren Mell, Samantha Seaward, Wade L. Thorstad, Jonathan Jay Beitler, Khalil Sultanem, Diagjin Blakaj, Quynh-Thu Le
Journal of Nuclear Medicine Mar 2023, 64 (3) 362-367; DOI: 10.2967/jnumed.122.264424

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18F-FDG PET/CT Prediction of Treatment Outcomes in Human Papillomavirus–Positive, Locally Advanced Oropharyngeal Cancer Patients Receiving Deintensified Therapy: Results from NRG-HN002
Rathan M. Subramaniam, Lyudmila DeMora, Min Yao, Sue S. Yom, Maura Gillison, Jimmy J. Caudell, John Waldron, Ping Xia, Christine H. Chung, Minh Tam Truong, Michelle Echevarria, Jason W. Chan, Jessica L. Geiger, Loren Mell, Samantha Seaward, Wade L. Thorstad, Jonathan Jay Beitler, Khalil Sultanem, Diagjin Blakaj, Quynh-Thu Le
Journal of Nuclear Medicine Mar 2023, 64 (3) 362-367; DOI: 10.2967/jnumed.122.264424
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Keywords

  • PET/CT negative predictive value
  • p16-positive oropharyngeal cancer
  • NRG-HN002
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