Skip to main content
SpringerLink
Log in

Use of pretreatment metabolic tumour volumes to predict the outcome of pharyngeal cancer treated by definitive radiotherapy

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to investigate the predictive role of pretreatment metabolic volume (MTV) in pharyngeal cancer (PC) patients treated with definitive (chemo) radiotherapy.

Methods

This retrospective analysis enrolled 64 patients with PC treated with (chemo) radiotherapy. All patients received pretreatment fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Four PET segmentation methods were used, namely applying an isocontour at a standardized uptake value (SUV) of either 2.5 or 3.0 (MTV2.5 and MTV3.0) or using fixed thresholds of either 40 or 50 % (MTV40 %, MTV50 %) of the maximum intratumoural FDG activity. Disease-free survival (DFS) and primary relapse-free survival (PRFS) were examined according to cutoffs of the median values for each MTV and the gross tumour volume (GTVp). Independent prognosticators were identified by Cox regression analysis.

Results

With a median follow-up of 24 months, 19 patients died, and 26 patients experienced tumour relapse at primary sites. Multivariate analysis of the DFS showed that MTV2.5 > 13.6 ml was the only predictor of relapse [p = 0.011, hazard ratio = 2.69, 95 % confidence interval (CI) 1.25–5.76]. The independent predictor for PRFS was MTV2.5 > 13.6 ml (p = 0.003, hazard ratio = 3.76, 95 % CI 1.57–8.92), whereas GTVp > 15.5 ml had a marginal impact on PRFS (p = 0.06, hazard ratio = 3.54, 95 % CI 0.97–11.85). Patients having tumours with MTV2.5 > 13.6 ml had a significantly inferior 2-year PRFS compared with patients who had lower MTV2.5 tumours (39 vs 72 %, respectively, p = 0.001).

Conclusion

For PC patients treated with definitive (chemo)radiotherapy, pretreatment MTV2.5 volume achieved the best predictive value for primary recurrence, and the same value was also a prognosticator for DFS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Studer G, Lütolf UM, El-Bassiouni M, Rousson V, Glanzmann C. Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT. Acta Oncol 2007;46:386–94.

    Article  PubMed  CAS  Google Scholar 

  2. Mancuso AA, Mukherji SK, Schmalfuss I, Mendenhall W, Parsons J, Pameijer F, et al. Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma. J Clin Oncol 1999;17:631–7.

    PubMed  CAS  Google Scholar 

  3. Schinagl DAX, Span PN, Oyen WJ, Kaanders JHAM. Can FDG PET predict radiation treatment outcome in head and neck cancer? Results of a prospective study. Eur J Nucl Med Mol Imaging 2011;38:1449–58.

    Article  PubMed  Google Scholar 

  4. Allal AS, Slosman DO, Kebdani T, Allaoua M, Lehmann W, Dulguerov P. Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18F]fluoro-2-deoxy-D-glucose. Int J Radiat Oncol Biol Phys 2004;59:1295–300.

    Article  PubMed  CAS  Google Scholar 

  5. Brun E, Kjellén E, Tennvall J, Ohlsson T, Sandell A, Perfekt R, et al. FDG PET studies during treatment: prediction of therapy outcome in head and neck squamous cell carcinoma. Head Neck 2002;24:127–35.

    Article  PubMed  Google Scholar 

  6. Halfpenny W, Hain SF, Biassoni L, Maisey MN, Sherman JA, McGurk M. FDG-PET. A possible prognostic factor in head and neck cancer. Br J Cancer 2002;86:512–6.

    Article  PubMed  CAS  Google Scholar 

  7. Lee SW, Nam SY, Im KC, Kim JS, Choi EK, Ahn SD, et al. Prediction of prognosis using standardized uptake value of 2-[(18)F]fluoro-2-deoxy-d-glucose positron emission tomography for nasopharyngeal carcinomas. Radiother Oncol 2008;87:211–6.

    Article  PubMed  CAS  Google Scholar 

  8. Machtay M, Natwa M, Andrel J, Hyslop T, Anne PR, Lavarino J, et al. Pretreatment FDG-PET standardized uptake value as a prognostic factor for outcome in head and neck cancer. Head Neck 2009;31:195–201.

    Article  PubMed  Google Scholar 

  9. Minn H, Lapela M, Klemi PJ, Grénman R, Leskinen S, Lindholm P, et al. Prediction of survival with fluorine-18-fluoro-deoxyglucose and PET in head and neck cancer. J Nucl Med 1997;38:1907–11.

    PubMed  CAS  Google Scholar 

  10. Roh JL, Pae KH, Choi SH, Kim JS, Lee S, Kim SB, et al. 2-[18F]-Fluoro-2-deoxy-D-glucose positron emission tomography as guidance for primary treatment in patients with advanced-stage resectable squamous cell carcinoma of the larynx and hypopharynx. Eur J Surg Oncol 2007;33:790–5.

    Article  PubMed  Google Scholar 

  11. Schwartz DL, Rajendran J, Yueh B, Coltrera MD, Leblanc M, Eary J, et al. FDG-PET prediction of head and neck squamous cell cancer outcomes. Arch Otolaryngol Head Neck Surg 2004;130:1361–7.

    Article  PubMed  Google Scholar 

  12. Chung MK, Jeong HS, Park SG, Jang JY, Son YL, Choi JY, et al. Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res 2009;15:5861–8.

    Article  PubMed  CAS  Google Scholar 

  13. Seol YM, Kwon BR, Song MK, Choi YJ, Shin HJ, Chung JS, et al. Measurement of tumor volume by PET to evaluate prognosis in patients with head and neck cancer treated by chemo-radiation therapy. Acta Oncol 2010;49:201–8.

    Article  PubMed  CAS  Google Scholar 

  14. La TH, Filion EJ, Turnbull BB, Chu JN, Lee P, Nguyen K, et al. Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys 2009;74:1335–41.

    Article  PubMed  Google Scholar 

  15. Soto DE, Kessler ML, Piert M, Eisbruch A. Correlation between pretreatment FDG-PET biological target volume and anatomical location of failure after radiation therapy for head and neck cancers. Radiother Oncol 2008;89:13–8.

    Article  PubMed  Google Scholar 

  16. Suzuki K, Nishioka T, Homma A, Tsuchiya K, Yasuda M, Aoyama H, et al. Value of fluorodeoxyglucose positron emission tomography before radiotherapy for head and neck cancer: does the standardized uptake value predict treatment outcome? Jpn J Radiol 2009;27:237–42.

    Article  PubMed  Google Scholar 

  17. Thorwarth D, Eschmann SM, Holzner F, Paulsen F, Alber M. Combined uptake of [18F]FDG and [18F]FMISO correlates with radiation treatment outcome in head-and-neck cancer patients. Radiother Oncol 2006;80:151–6.

    Article  PubMed  CAS  Google Scholar 

  18. Vernon MR, Maheshwari M, Schultz CJ, Michel MA, Wong SJ, Campbell BH, et al. Clinical outcomes of patients receiving integrated PET/CT-guided radiotherapy for head and neck carcinoma. Int J Radiat Oncol Biol Phys 2008;70:678–84.

    Article  PubMed  Google Scholar 

  19. Kao CH, Hsieh TC, Yu CY, Yen KY, Yang SN, Wang YC, et al. 18F-FDG PET/CT-based gross tumor volume definition for radiotherapy in head and neck cancer: a correlation study between suitable uptake value threshold and tumor parameters. Radiat Oncol 2010;5:76.

    Article  PubMed  Google Scholar 

  20. Heron DE, Andrade RS, Flickinger J, Johnson J, Agarwala SS, Wu A, et al. Hybrid PET-CT simulation for radiation treatment planning in head-and-neck cancers: a brief technical report. Int J Radiat Oncol Biol Phys 2004;60:1419–24.

    Article  PubMed  Google Scholar 

  21. Nishioka T, Shiga T, Shirato H, Tsukamoto E, Tsuchiya K, Kato T, et al. Image fusion between 18FDG-PET and MRI/CT for radiotherapy planning for oropharyngeal and nasopharyngeal carcinomas. Int J Radiat Oncol Biol Phys 2002;53:1051–7.

    Article  PubMed  Google Scholar 

  22. Chen SW, Yang SN, Liang JA, Lin FJ, Tsai MH. Prognostic impact of tumor volume in patients with stage III-IVA hypopharyngeal cancer without bulky lymph nodes treated with definitive concurrent chemoradiotherapy. Head Neck 2009;31:709–16.

    Article  PubMed  Google Scholar 

  23. Minn H, Clavo AC, Grénman R, Wahl RL. In vitro comparison of cell proliferation kinetics and uptake of tritiated fluorodeoxyglucose and L-methionine in squamous-cell carcinoma of the head and neck. J Nucl Med 1995;36:252–8.

    PubMed  CAS  Google Scholar 

  24. Clavo AC, Brown RS, Wahl RL. Fluorodeoxyglucose uptake in human cancer cell lines is increased by hypoxia. J Nucl Med 1995;36:1625–32.

    PubMed  CAS  Google Scholar 

  25. Furuta M, Hasegawa M, Hayakawa K, Yamakawa M, Ishikawa H, Nonaka T, et al. Rapid rise in FDG uptake in an irradiated human tumour xenograft. Eur J Nucl Med 1997;24:435–8.

    PubMed  CAS  Google Scholar 

  26. Nair VS, Krupitskaya Y, Gould MK. Positron emission tomography 18F-fluorodeoxyglucose uptake and prognosis in patients with surgically treated, stage I non-small cell lung cancer: a systematic review. J Thorac Oncol 2009;4:1473–9.

    Article  PubMed  Google Scholar 

  27. de Geus-Oei LF, van Krieken JH, Aliredjo RP, Krabbe PF, Frielink C, Verhagen AF, et al. Biological correlates of FDG uptake in non-small cell lung cancer. Lung Cancer 2007;55:79–87.

    Article  PubMed  Google Scholar 

  28. Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med 2004;45:1431–4.

    PubMed  Google Scholar 

  29. Lee JR, Madsen MT, Bushnel D, Menda Y. A threshold method to improve standardized uptake value reproducibility. Nucl Med Commun 2000;21:685–90.

    Article  PubMed  CAS  Google Scholar 

  30. Lee P, Weerasuriya D, Lavori PW, Quon A, Hara W, Maxim PG, et al. Metabolic tumor burden predicts for disease progression and death in lung cancer. Int J Radiat Oncol Biol Phys 2007;69:328–33.

    Article  PubMed  Google Scholar 

  31. Huang W, Zhou T, Ma L, Sun H, Gong H, Wang J, et al. Standard uptake value and metabolic tumor volume of 18F-FDG PET/CT predict short-term outcome early in the course of chemoradiotherapy in advanced non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2011;38:1628–35.

    Article  PubMed  CAS  Google Scholar 

  32. Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010;363:24–35.

    Article  PubMed  CAS  Google Scholar 

  33. Shaw R, Robinson M. The increasing clinical relevance of human papillomavirus type 16 (HPV-16) infection in oropharyngeal cancer. Br J Oral Maxillofac Surg 2011;49:423–9.

    Article  PubMed  Google Scholar 

  34. Chien CY, Su CY, Fang FM, Huang HY, Chuang HC, Chen CM, et al. Lower prevalence but favorable survival for human papillomavirus-related squamous cell carcinoma of tonsil in Taiwan. Oral Oncol 2008;44:174–9.

    Article  PubMed  CAS  Google Scholar 

  35. Li W, Tran N, Lee CS, O’Brien CJ, Tse GM, Scolyer RA, et al. New evidence for geographic variation in the role of human papillomavirus in tonsillar carcinogenesis. Pathology 2007;39:217–22.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We wish to express our thanks for the study grants we received for projects DMR-100-078 and DMR-100-110 conducted in our hospital, issued by the Taiwan Department of Health Clinical Trial and Research Center for Excellence (DOH101-TD-B-111-004), and Taiwan Department of Health Cancer Research Center for Excellence (DOH101-TD-C-111-005).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    Chia-Hung Kao, Te-Chun Hsieh & Kuo-Yang Yen

  2. Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

    Shih-Chieh Lin, Shih-Neng Yang, Yao-Ching Wang, Ji-An Liang & Shang-Wen Chen

  3. Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Chia-Hung Kao, Ji-An Liang & Shang-Wen Chen

  4. Institute of Clinical Medicine Science and School of Medicine, Taipei Medical University, Taipei, Taiwan

    Shang-Wen Chen

  5. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan

    Kuo-Yang Yen & Shih-Neng Yang

  6. Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan

    Chun-Hung Hua

  7. Department of Nuclear Medicine and PET center, China Medical University Hospital, No 2. Yur-Der Road, Taichung, 404, Taiwan

    Chia-Hung Kao

  8. Department of Radiation Oncology, China Medical University Hospital, No 2. Yur-Der Road, Taichung, 404, Taiwan

    Shang-Wen Chen

Authors
  1. Chia-Hung Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shih-Chieh Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Te-Chun Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kuo-Yang Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shih-Neng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yao-Ching Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ji-An Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chun-Hung Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shang-Wen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Chia-Hung Kao or Shang-Wen Chen.

Additional information

Shang-Wen Chen and Chia-Hung Kao contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kao, CH., Lin, SC., Hsieh, TC. et al. Use of pretreatment metabolic tumour volumes to predict the outcome of pharyngeal cancer treated by definitive radiotherapy. Eur J Nucl Med Mol Imaging 39, 1297–1305 (2012). https://doi.org/10.1007/s00259-012-2127-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-012-2127-7

Keywords

Search

Navigation