Clin Exp Otorhinolaryngol.  2015 Jun;8(2):142-148. 10.3342/ceo.2015.8.2.142.

Prognostic Value of Volume-Based Positron Emission Tomography/Computed Tomography in Patients With Nasopharyngeal Carcinoma Treated With Concurrent Chemoradiotherapy

• Moon SH
• Choi JY
• Lee HJ
• Son YI
• Baek CH
• Ahn YC
• Ahn MJ
• Park K
• Kim BT

• KMID: 2360785
• DOI: http://doi.org/10.3342/ceo.2015.8.2.142

Abstract

OBJECTIVES
The aim of this study was to evaluate the prognostic value of volume-based metabolic parameters measured by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in patients with nasopharyngeal carcinoma (NPC).
METHODS
Forty-four NPC patients who underwent 18F-FDG PET/CT for initial staging work-up before concurrent chemoradiotherapy (CCRT) were retrospectively evaluated. Maximum standardized uptake value (SUV), mean SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors were measured. The prognostic significance and predictive performance of these parameters were assessed by Cox proportional hazards regression analysis and time-dependent receiver operating characteristics (ROC) curve analysis.
RESULTS
Multivariate analysis showed that American Joint Committee on Cancer stage 7th edition (hazard ratio [HR], 1.525; 95% confidence interval [CI], 1.062 to 2.188; P=0.022), and TLG (HR, 7.799; 95% CI, 2.622 to 23.198; P< or =0.001) were independent predictive factors associated with decreased disease-free survival (DFS). Time-dependent ROC curve analysis indicated that TLG was a better predictor of DFS than MTV (P=0.008).
CONCLUSION
The TLG of the primary tumor was a significant independent metabolic prognostic factor of DFS in patients with NPC treated with CCRT.

Keyword

Fluorodeoxyglucose F18; Positron-Emission Tomography; Nasopharyngeal Carcinoma; Tumor Burden; Prognosis

MeSH Terms

Chemoradiotherapy*
Disease-Free Survival
Electrons*
Fluorodeoxyglucose F18
Glycolysis
Humans
Joints
Multivariate Analysis
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography
Prognosis
Retrospective Studies
ROC Curve
Tumor Burden
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Initial 18F-fluorodeoxyglucose (FDG) positron emission tomography images of a nasopharyngeal carcinoma in a 73-year-old female patient. (A) The increased FDG uptake by the primary tumor in the nasopharynx is clearly visible in the maximum intensity projection image. A volume of interest (VOI) was automatically placed over the primary tumor using an isocontour threshold method. Segmented VOIs are shown on the transverse (B), sagittal (C), and coronal (D) images.

• 

  Fig. 2 Disease-free survival stratified by total lesion glycolysis (TLG) (A) and metabolic tumor volume (MTV) (B) in patients with nasopharyngeal carcinoma treated with concurrent chemoradiotherapy.

• 

  Fig. 3 Time-dependent receiver operating characteristics curve analysis for disease-free survival prediction according to MTV (continuous variable) and TLG (continuous variable). Integrated area under the curve (IAUC) of TLG and MTV were 0.768 and 0.749, respectively. The IAUC of TLG was significantly larger than that of MTV (P<0.008). MTV, metabolic tumor volume; TLG, total lesion glycolysis.

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