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Changes in 18F-fluorothymidine and 18F-fluorodeoxyglucose positron emission tomography imaging in patients with head and neck cancer treated with chemoradiotherapy

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Abstract

Objective

This study compared change of 18F-fluorothymidine (FLT) uptake with that of 18F-fluorodeoxyglucose (FDG) in head and neck squamous cell cancer (HNSCC) patients during and after treatment and evaluated the utility for early monitoring of response to chemoradiotherapy.

Methods

Thirty patients with newly diagnosed HNSCCs treated with concurrent chemoradiotherapy underwent FLT and FDG PET in pre-treatment (PET1), mid-treatment (PET2) and post-treatment (PET3) stages. The PET images were evaluated quantitatively using maximum standardized uptake values (SUVs). Ratios between SUVs at PET2 and PET3 were also calculated.

Results

According to the SUVs, no significant differences were found with primary site location, cellular differentiation and T category in all PET scans. About a 78 % median decrease in FLT SUV was observed at the total dose (TD) of 30 Gy and no apparent change was observed thereafter. About a 40 % decrease in FDG SUV was observed at TD 30 Gy and significant decreases were then found at the 4- and 6-week time points after the therapy. FLT PET demonstrated no recurrence regions in patients with a PET3/PET2 ratio of <1.5. In comparison, FLT SUVs in PET3 with recurrence were increased more than three times. However, no significant difference was found between the values with recurrence and those with no recurrence in FDG PET.

Conclusion

FLT PET signal change preceded FDG PET change and the increase of FLT uptake after the therapy can imply recurrence or a residual tumor. FLT PET seems promising for early evaluation of chemoradiation effects in HNSCCs.

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References

  1. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.

    Article  PubMed  CAS  Google Scholar 

  2. Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, et al. Final results of the 94–01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol. 2004;22:69–76.

    Article  PubMed  Google Scholar 

  3. Sassler AM, Esclamado RM, Wolf GT. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg. 1995;121:162–5.

    Article  PubMed  CAS  Google Scholar 

  4. Nam SY, Lee SW, Im KC, Kim JS, Kim SY, Choi SH, et al. Early evaluation of the response to radiotherapy of patients with squamous cell carcinoma of the head and neck using 18FDG-PET. Oral Oncol. 2005;41:390–5.

    Article  PubMed  CAS  Google Scholar 

  5. MacManus MP, Seymour JF, Hicks RJ. Overview of early response assessment in lymphoma with FDG-PET. Cancer Imaging. 2007;7:10–8.

    Article  PubMed  Google Scholar 

  6. Kumar A, Kumar R, Seenu V, Gupta SD, Chawla M, Malhotra A, et al. The role of 18F-FDG PET/CT in evaluation of early response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. Eur Radiol. 2009;19:1347–57.

    Article  PubMed  Google Scholar 

  7. Kikuchi M, Nakamoto Y, Shinohara S, Fujiwara K, Yamazaki H, Kanazawa Y, et al. Early evaluation of neoadjuvant chemotherapy response using FDG-PET/CT predicts survival prognosis in patients with head and neck squamous cell carcinoma. Int J Clin Oncol 2012; 9 [Epub ahead of print].

  8. Sunaga N, Oriuchi N, Kaira K, Yanagitani N, Tomizawa Y, Hisada T, et al. Usefulness of FDG-PET for early prediction of the response to gefitinib in non-small cell lung cancer. Lung Cancer. 2008;59:203–10.

    Article  PubMed  Google Scholar 

  9. Mileshkin L, Hicks RJ, Hughes BG, Mitchell PL, Charu V, Gitlitz BJ, et al. Changes in 18F-fluorodeoxyglucose and 18F-fluorodeoxythymidine positron emission tomography imaging in patients with non-small cell lung cancer treated with erlotinib. Clin Cancer Res. 2011;17:3304–15.

    Article  PubMed  CAS  Google Scholar 

  10. Greven KM, Williams DW III, Frederick McGuirt SrW, Harkness BA, D’Agostino RB Jr, Keyes JW Jr, et al. Serial positron emission tomography scans following radiation therapy of patients with head and neck cancer. Head Neck. 2001;23:942–6.

    Article  PubMed  CAS  Google Scholar 

  11. Conessa C, Hervé S, Foehrenbach H, Poncet JL. FDG-PET scan in local follow-up of irradiated head and neck squamous cell carcinomas. Ann Otol Rhinol Laryngol. 2004;113:628–35.

    PubMed  Google Scholar 

  12. Koike I, Ohmura M, Hata M, Takahashi N, Oka T, Ogino I, et al. FDG-PET scanning after radiation can predict tumor regrowth three months later. Int J Radiat Oncol Biol Phys. 2003;57:1231–8.

    Article  PubMed  Google Scholar 

  13. Shields AF, Larson SM, Grunbaum Z, Graham MM. Short-term thymidine uptake in normal and neoplastic tissues: studies for PET. J Nucl Med. 1984;25:759–64.

    PubMed  CAS  Google Scholar 

  14. Rasey JS, Grierson JR, Wiens LW, Kolb PD, Schwartz JL. Validation of FLT uptake as a measure of thymidine kinase-1 activity in A549 carcinoma cells. J Nucl Med. 2002;43:1210–7.

    PubMed  CAS  Google Scholar 

  15. van Waarde A, Cobben DC, Suurmeijer AJ, Maas B, Vaalburg W, de Vries EF, et al. Selectivity of 18F-FLT and 18F-FDG for differentiating tumor from inflammation in a rodent model. J Nucl Med. 2004;45:695–700.

    PubMed  Google Scholar 

  16. Lee TS, Ahn SH, Moon BS, Chun KS, Kang JH, Cheon GJ, et al. Comparison of 18F-FDG, 18F-FET and 18F-FLT for differentiation between tumor and inflammation in rats. Nucl Med Biol. 2009;36:681–6.

    Article  PubMed  CAS  Google Scholar 

  17. Apisarnthanarax S, Alauddin MM, Mourtada F, Ariga H, Raju U, Mawlawi O, et al. Early detection of chemoradioresponse in esophageal carcinoma by 3′-deoxy-3′-3H-fluorothymidine using preclinical tumor models. Clin Cancer Res. 2006;12:4590–7.

    Article  PubMed  CAS  Google Scholar 

  18. Sobin LH, Wittecind C. TNM classification of malignant tumors. 6th ed. New York: Wiley-Liss; 2002.

    Google Scholar 

  19. Herrmann K, Krause BJ, Bundschuh RA, Dechow T, Schwaiger M. Monitoring response to therapeutic interventions in patients with cancer. Semin Nucl Med. 2009;39:210–32.

    Article  PubMed  Google Scholar 

  20. 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 

  21. Ceulemans G, Voordeckers M, Farrag A, Verdries D, Storme G, Everaert H. Can 18-FDG-PET during radiotherapy replace post-therapy scanning for detection/demonstration of tumor response in head-and-neck cancer? Int J Radiat Oncol Biol Phys. 2011;81:938–42.

    Article  PubMed  Google Scholar 

  22. Buck AK, Kratochwil C, Glatting G, Juweid M, Bommer M, Tepsic D, et al. Early assessment of therapy response in malignant lymphoma with the thymidine analogue [18F]FLT. Eur J Nucl Med Mol Imaging. 2007;34:1775–82.

    Article  PubMed  CAS  Google Scholar 

  23. Yue J, Chen L, Cabrera AR, Sun X, Zhao S, Zheng F, et al. Measuring tumor cell proliferation with18f-flt pet during radiotherapy of esophageal squamous cell carcinoma: a pilot clinical study. J Nucl Med. 2010;51:528–34.

    Article  PubMed  Google Scholar 

  24. Kenny L, Coombes RC, Vigushin DM, Al-Nahhas A, Shousha S, Aboagye EO. Imaging early changes in proliferation at 1 week post chemotherapy: a pilot study in breast cancer patients with 3′-deoxy-3′-[18F]fluorothymidine positron emission tomography. Eur J Nucl Med Mol Imaging. 2007;34:1339–47.

    Article  PubMed  Google Scholar 

  25. Herrmann K, Wieder HA, Buck AK, Schöffel M, Krause B-J, Fend F, et al. Early response assessment using 3′-deoxy-3′-[18F]fluorothymidine-positron emission tomography in high-grade non-Hodgkin’s lymphoma. Clin Cancer Res. 2007;13:3552–8.

    Article  PubMed  CAS  Google Scholar 

  26. Chen W, Delaloye S, Silverman DHS, Geist C, Czernin J, Sayre J, et al. Predicting treatment response of malignant gliomas to bevacizumab and irinotecan by imaging proliferation with [18F] fluorothymidine positron emission tomography: a pilot study. J Clin Oncol. 2007;25:4714–21.

    Article  PubMed  CAS  Google Scholar 

  27. Kasper B, Egerer G, Gronkowski M, Haufe S, Lehnert T, Eisenhut M, et al. Functional diagnosis of residual lymphomas after radiochemotherapy with positron emission tomography comparing FDG- and FLT-PET. Leuk Lymphoma. 2007;48:746–53.

    Article  PubMed  Google Scholar 

  28. Menda Y, Boles Ponto LL, Dornfeld KJ, Tewson TJ, Watkins GL, et al. Kinetic analysis of 3′-deoxy-3′-18F-fluorothymidine (18F-FLT) in head and neck cancer patients before and early after initiation of chemoradiation therapy. J Nucl Med. 2009;50:1028–35.

    Article  PubMed  CAS  Google Scholar 

  29. Troost EG, Bussink J, Hoffmann AL, Boerman OC, Oyen WJ, Kaanders JH. 18F-FLT PET/CT for early response monitoring and dose escalation in oropharyngeal tumors. J Nucl Med. 2010;51:866–74.

    Article  PubMed  Google Scholar 

  30. Hoshikawa H, Nishiyama Y, Kishino T, Yamamoto Y, Haba R, Mori N. Comparison of FLT-PET and FDG-PET for visualization of head and neck squamous cell cancers. Mol Imaging Biol. 2011;13:172–7.

    Article  PubMed  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Department of Otolaryngology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Hiroshi Hoshikawa, Terushige Mori, Takehito Kishino, Ryuhei Inamoto, Kosuke Akiyama & Nozomu Mori

  2. Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Yuka Yamamoto & Yoshihiro Nishiyama

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  1. Hiroshi Hoshikawa
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  2. Terushige Mori
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Correspondence to Hiroshi Hoshikawa.

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Hoshikawa, H., Mori, T., Kishino, T. et al. Changes in 18F-fluorothymidine and 18F-fluorodeoxyglucose positron emission tomography imaging in patients with head and neck cancer treated with chemoradiotherapy. Ann Nucl Med 27, 363–370 (2013). https://doi.org/10.1007/s12149-013-0694-8

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  • DOI: https://doi.org/10.1007/s12149-013-0694-8

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