Cancer Res Treat.  2016 Jul;48(3):928-941. 10.4143/crt.2015.275.

The Clinical Usefulness of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography (PET) to Predict Oncologic Outcomes and PET-Based Radiotherapeutic Considerations in Locally Advanced Nasopharyngeal Carcinoma

• Yoon HI
• Kim KH
• Lee J
• Roh YH
• Yun M
• Cho BC
• Lee CG
• Keum KC

• KMID: 2344065
• DOI: http://doi.org/10.4143/crt.2015.275

Abstract

PURPOSE
We investigated ¹â¸F-fluorodeoxyglucose positron emission tomography (PET)-derived parameters as prognostic indices for disease progression and survival in locally advanced nasopharyngeal carcinoma (NPC) and the effect of high-dose radiotherapy for a subpopulation with PET-based poor prognoses.
MATERIALS AND METHODS
Ninety-seven stage III and Iva-b NPC patients who underwent definitive treatment and PET were reviewed. For each primary, nodal, and whole tumor, maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) were evaluated.
RESULTS
Based on the C-index (0.666) and incremental area under the curve (0.669), the whole tumor TLGwas the most useful predictorfor progression-free survival (PFS); thewhole tumor TLG cut-off value showing the best predictive performance was 322.7. In multivariate analysis, whole tumor TLG was a significant prognostic factor for PFS (hazard ratio [HR], 0.3; 95% confidence interval [CI], 0.14 to 0.65; p=0.002) and OS (HR, 0.29; 95% CI, 0.11 to 0.79; p=0.02). Patients with low whole tumor TLG showed the higher 5-year PFS in the subgroup for only patients receiving intensity modulated radiotherapy (77.4% vs. 53.0%, p=0.01). In the subgroup of patients with high whole tumor TLG, patients receiving an EQD₂≥ 70 Gy showed significantly greater complete remission rates (71.4% vs. 33.3%, p=0.03) and higher 5-year OS (74.7% vs. 19.6%, p=0.02).
CONCLUSION
Our findings demonstrated that whole tumor TLG could be an independent prognostic factor and high-dose radiotherapy could improve outcomes for NPC showing high whole tumor TLG.

Keyword

Nasopharyngeal carcinoma; ¹⁸F-fluorodeoxyglucose; Positron emission tomography; Radiotherapy dosage; Intensity-modulated radiotherapy

MeSH Terms

Disease Progression
Disease-Free Survival
Electrons*
Glycolysis
Humans
Multivariate Analysis
Positron-Emission Tomography*
Prognosis
Radiotherapy
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated
Tumor Burden

Figure

• 

  Fig. 1. Kaplan-Meier curves demonstrate the survival difference between high and low total lesion glycolysis (TLG) of the whole tumor. (A) Progression-free survival. (B) Overall survival. (C) Loco-regional failure-free survival. (D) Distant failure-free survival.

• 

  Fig. 2. Kaplan-Meier curves of progression-free survival (A), overall survival (B), loco-regional failure-free survival (C), and distant failure-free survival (D) for subgroup of the only patients receiving intensity modulated radiotherapy. TLG, total lesion glycolysis.

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  Fig. 3. Kaplan-Meier curves demonstrate survival differences after propensity-matching analysis to adjust for differences in TNM staging between high and low total lesion glycolysis (TLG) of the whole tumor. (A) Progression-free survival. (B) Locoregional failure-free survival. (C) Distant failure-free survival. (D) Overall survival.

• 

  Fig. 4. Kaplan-Meier curves demonstrate the differences in progression-free survival and overall survival according to equivalent dose in 2 Gy fractions (EQD2) in subgroup of patients with high total lesion glycolysis of the whole tumor. (A) Progression-free survival. (B) Overall survival.

Reference

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