The role of 18F-FDG PET/CT metabolic tumour volume in predicting survival in patients with metastatic nasopharyngeal carcinoma
Introduction
Nasopharyngeal carcinoma (NPC) differs from other cancers of the head and neck in its epidemiology, histopathology, methods of treatment, and failure patterns.1 Despite improvements in locoregional control after applying chemoradiotherapy, distant failure is still the predominant cause of death from NPC.[1], [2], [3]
In contrast to other head and neck cancers, several reports have described patients with metastatic NPC who achieve long-term survival after salvage treatment.[4], [5] Therefore, it is important to define reliable prognostic factors for metastatic NPC and to identify which group of metastatic NPC patients will benefit from salvage treatment. Although the prognostic factors for metastatic NPC have been studied by several investigators,[4], [5], [6] most of the proposed prognostic factors have been limited to clinical characteristics. A more refined prognostic system is desirable, because this could guide the selection of salvage therapies and allow individualisation of treatment.
Glucose metabolism of the tumour has been proved to be associated with the prognosis of the head and neck cancer patients. Many reports in literature indicate standardised uptake value (SUV) on 18F-FDG PET/CT is an important prognostic factor for head and neck malignancy, including NPC.[7], [8], [9], [10] In a previous study, we have shown that combined information of SUV and tumour staging may guide the use of therapy and surveillance protocols to improve disease control of primary NPC patients.9 Recently, other PET semi-quantitative parameters such as metabolic tumour volume (MTV) or total lesion glycolysis (TLG) are becoming a topic of interest in head and neck cancer research.[11], [12], [13], [14] Our recent report has shown that these parameters are important independent risk factors in primary NPC patients.13 Although studies have examined PET/CT imaging as a predictor of treatment outcome in the primary head and neck carcinoma, significantly less is known about how these PET parameter can be used as a prognostic factor in metastatic disease. Furthermore, no report has validated the prognostic value of MTV in patients with metastatic NPC.
In contrast, there is accumulating evidence that supports using blood biomarkers for NPC detection and prognostication. The plasma Epstein–Barr virus (EBV) DNA level is the most validated of these biomarkers.[15], [16], [17] NPC is an EBV-associated cancer, and the EBV genome is present intracellularly in almost every case of primary and metastatic NPC. Several authors have also reported that the plasma EBV DNA level can help predict survival in metastatic/recurrent NPC.[15], [17], [18]
In this study, we sought to investigate the value of PET-derived parameters for predicting metastatic NPC outcomes. We also assessed the potential interactive role of PET parameters and plasma EBV DNA levels.
Section snippets
Study participants
Consecutive metastatic NPC patients admitted to our hospital were eligible for this prospective study. The following inclusion criteria were used for recruitment into the study: (1) biopsy-proven NPC; (2) metastatic disease that was newly diagnosed or had relapsed after a previous local curative treatment and was proven by biopsy or at least two study images; and (3) acceptable internal organ function, including bone marrow function (white blood cell count > 3000/L and platelet count > 75,000/L),
The patients and results of univariate analysis
Between December 2006 and May 2009, 56 eligible patients were included in the study. Table 1 shows the general characteristics of the study participants. Distant metastases were found in bone, lung, liver, distant lymph nodes, and other distant sites. Thirty-five patients had a single metastatic organ site. Of these 35 patients, 14 had metastatic spread to the bone, 10 to the lung, 8 to the liver, and 3 to the distant lymph nodes. The remaining twenty-one patients had metastases to several
Discussion
Among head and neck cancers, NPC has the highest incidence of distant metastasis,1 which has been shown to be the strongest determinant of survival.[25], [26], [27], [28] Studies have indicated that some patients with metastatic NPC can achieve long-term progression-free or overall survival after salvage treatment.[4], [5] However, a reliable prognostic system for these patients is still lacking. Recently, investigators have indicated that the plasma EBV DNA titre is an important biomarker for
Conflict of interest statement
None declared.
Acknowledgements
This work was supported by the National Science Council Grant Nos. 97∼99-2314-B-182A-103-MY3, 100-2314-B-182A-053, 101-2314-B-182A-079, and CMRPG 370081-3 (Chang Gung Memorial Hospital, Taiwan, Republic of China). The authors thank all the members of the Cancer Center, Chang Gung Memorial Hospital, Keelung, for their invaluable help and Yu-Jr Lin in Biostatistical Center for Clinical Research in Chang Gung Memorial Hospital for the statistic consultation.
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2023, Clinical Lung CancerPretreatment <sup>18</sup>F-FDG PET/CT texture parameters provide complementary information to Epstein-Barr virus DNA titers in patients with metastatic nasopharyngeal carcinoma
2020, Oral OncologyCitation Excerpt :Compared with conventional anatomic imaging, PET/CT provides functional information on tumor glucose metabolism – which may serve as a proxy for the total tumor burden and its biological aggressiveness. Numerous studies have shown that traditional PET-derived parameters – including standardized uptake value (SUV) and metabolic tumor volume (MTV) – predict prognosis in patients with primary NPC [8–17]. However, the question as to whether PET texture analysis – which can detect and quantify local differences in tumor morphology and function – can predict clinical outcomes in this patient group has not been fully elucidated.
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2019, Nasopharyngeal Carcinoma: From Etiology to Clinical PracticeHypoxic volume evaluated by <sup>18</sup>F-fluoromisonidazole positron emission tomography (FMISO-PET) may be a prognostic factor in patients with oral squamous cell carcinoma: preliminary analyses
2018, International Journal of Oral and Maxillofacial SurgeryCitation Excerpt :None of the 17 patients who received preoperative chemotherapy underwent preoperative radiation therapy. Postoperative radiation therapy was administered to five patients (patients 1, 2, 13, 19, and 22); these patients had advanced pT tumours, more than three pathologically positive lymph nodes23, pathological close margins in the primary tumour, or pathological extracapsular invasion of positive lymph nodes24. All 23 patients underwent FMISO-PET CT and FDG-PET CT before surgery, as described previously14.
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2017, PET ClinicsCitation Excerpt :Wang and colleagues44 also investigated the implication of EBV DNA assay and 18F-FDG-PET in the detection of recurrent NPC. Chan and colleagues40 evaluated the role of 18F-FDG-PET/CT in predicting survival in 56 patients with metastatic NPC. EBV DNA titer greater than 5000 copies/mL (P = .001) and MTV greater than 110 mL (P = .013) were found to be independent factors for PFS.
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These authors contributed equally to this work.