Volumetric 18 F-FDG-PET parameters as predictors of locoregional failure in low-risk HPV-related oropharyngeal cancer after definitive chemoradiation therapy.

Published on Dec 12, 2018in Head and Neck-journal for The Sciences and Specialties of The Head and Neck2.538
· DOI :10.1002/HED.25505
Thong Chotchutipan2
Estimated H-index: 2
(UM: University of Michigan),
B.S. Rosen7
Estimated H-index: 7
(UM: University of Michigan)
+ 6 AuthorsMichelle Mierzwa15
Estimated H-index: 15
(UM: University of Michigan)
BACKGROUND: We sought to investigate the prognostic value of volumetric positron emission tomography (PET) parameters in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and a ≤10 pack-year smoking history treated with chemoradiation. METHODS: A total of 142 patients were included. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor, involved regional lymph nodes, and total lesion were calculated. Cox proportional hazard modeling was used to evaluate associations of clinical and PET parameters with locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS). RESULTS: On univariate analysis, volumetric PET parameters were significantly associated with all endpoints, and 8th edition American Joint Committee on Cancer/Union Internationale Contre le Cancer staging was significantly associated with DMFS and OS. On multivariate analysis, total lesion TLG was significantly associated with LRFFS, while staging was most significantly prognostic for DMFS and OS. CONCLUSION: Volumetric PET parameters are uniquely prognostic of LRFFS in low-risk HPV-related OPSCC and may be useful for directing de-intensification strategies.
📖 Papers frequently viewed together
8 Citations
133 Citations
#1Bhishamjit S. CheraH-Index: 26
#2Robert J. AmdurH-Index: 63
Last. William M. MendenhallH-Index: 109
view all 13 authors...
BACKGROUND: The purpose of the current study was to determine quality of life and tumor control from a prospective phase 2 clinical trial evaluating deintensified chemoradiotherapy for favorable risk, human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma. METHODS: Patients with T0-T3, N0-N2c, M0, p16-positive disease and a minimal smoking history were treated with 60 grays of intensity-modulated radiotherapy with concurrent weekly intravenous cisplatin (30 mg/m2 ). The prim...
46 CitationsSource
#1Gustavo Trautman Stock (USP: University of São Paulo)H-Index: 3
Last. Gilberto de CastroH-Index: 24
view all 3 authors...
PURPOSE OF REVIEW: Oropharyngeal cancer (OPC) incidence is increasing worldwide, especially in developed countries where it seems to be etiologically related to the elevating rates of high-risk human papillomavirus (HPV) infection. Considered a distinct disease because of its weak correlation with the traditional risk factors (tobacco use and alcohol), it has different patterns of survival outcomes, locoregional and distant failure, generally with better prognosis independently of the treatment....
9 CitationsSource
#1Allen M. Chen (UCLA: University of California, Los Angeles)H-Index: 18
#2Carol Felix (UCLA: University of California, Los Angeles)H-Index: 5
Last. Megan E. Daly (UC Davis: University of California, Davis)H-Index: 31
view all 18 authors...
Summary Background Head and neck cancers positive for human papillomavirus (HPV) are exquisitely radiosensitive. We investigated whether chemoradiotherapy with reduced-dose radiation would maintain survival outcomes while improving tolerability for patients with HPV-positive oropharyngeal carcinoma. Methods We did a single-arm, phase 2 trial at two academic hospitals in the USA, enrolling patients with newly diagnosed, biopsy-proven stage III or IV squamous-cell carcinoma of the oropharynx, posi...
140 CitationsSource
#1Esther Mena (UTSW: University of Texas Southwestern Medical Center)H-Index: 23
#2Mehdi Taghipour (Johns Hopkins University)H-Index: 13
Last. Rathan M. SubramaniamH-Index: 41
view all 7 authors...
ObjectiveThe aim of this study was to evaluate the impact of intratumoral metabolic heterogeneity and quantitative FDG PET/CT imaging parameters for predicting patient outcomes in primary oropharyngeal squamous cell cancer (OPSCC).Patients and MethodsWe retrospectively investigated 105 patients with
22 CitationsSource
#1Shanthi Marur (Johns Hopkins University)H-Index: 20
#2Shuli Li (Harvard University)H-Index: 24
Last. Barbara Burtness (Yale University)H-Index: 63
view all 17 authors...
PurposeHuman papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC) is treatment-responsive. Definitive chemoradiation results in high cure rates but causes long-term toxicity and may represent overtreatment of some patients. This phase II trial evaluated whether complete clinical response (cCR) to induction chemotherapy (IC) could select patients with HPV-associated OPSCC for reduced radiation dose as a means of sparing late sequelae.MethodsPatients with HPV16 and/or p16-...
202 CitationsSource
#1Jon CacicedoH-Index: 11
#2Arturo NavarroH-Index: 5
Last. Alan Dal PraH-Index: 15
view all 13 authors...
Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT (18F-F...
27 CitationsSource
#1Erqi L. Pollom (Stanford University)H-Index: 17
#2Jie Song (Stanford University)H-Index: 14
Last. Wendy Hara (Stanford University)H-Index: 19
view all 11 authors...
Background Prognostic metabolic imaging indices are needed for risk stratification for patients with locally advanced oropharyngeal cancer. Methods We retrospectively examined pretreatment and midtreatment fluorodeoxyglucose-positron emission tomography (FDG-PET) parameters in patients with locally advanced oropharyngeal cancer who were treated with definitive chemoradiation. Results A total of 74 patients were evaluated. Pretreatment metabolic tumor volume (MTV) using threshold of 50% standardi...
16 CitationsSource
#1Brian O'Sullivan (Princess Margaret Cancer Centre)H-Index: 110
#2Shao Hui Huang (Princess Margaret Cancer Centre)H-Index: 33
Last. Wei Xu (Princess Margaret Cancer Centre)H-Index: 124
view all 23 authors...
Summary Background Human papillomavirus-related (HPV+) oropharyngeal cancer is a rapidly emerging disease with generally good prognosis. Many prognostic algorithms for oropharyngeal cancer incorporate HPV status as a stratification factor, rather than recognising the uniqueness of HPV+ disease. The International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) aimed to develop a TNM classification specific to HPV+ oropharyngeal cancer. Methods The ICON-S study included patients...
353 CitationsSource
#1Jeffrey M. Vainshtein (UM: University of Michigan)H-Index: 16
#2Matthew E. Spector (UM: University of Michigan)H-Index: 26
Last. Avraham Eisbruch (UM: University of Michigan)H-Index: 81
view all 12 authors...
Background The purpose of this study was to determine whether matted nodes uniquely identify patients with human papillomavirus (HPV)-positive oropharyngeal cancer at disproportionately high distant failure risk who may benefit from intensified systemic therapy. Methods One hundred seventy-eight patients with stage III/IV HPV-positive oropharyngeal cancer who completed definitive chemoradiotherapy were stratified by risk group (low-risk = T1–3/N0–2c/<10 pack-years; intermediate-risk = T1–3/N0–2c...
27 CitationsSource
#1Bhishamjit S. Chera (UNC: University of North Carolina at Chapel Hill)H-Index: 26
#2Robert J. Amdur (UF: University of Florida)H-Index: 63
Last. William M. Mendenhall (UF: University of Florida)H-Index: 109
view all 15 authors...
Purpose To perform a prospective, multi-institutional, phase 2 study of a substantial decrease in concurrent chemoradiation therapy (CRT) intensity as primary treatment for favorable-risk, human papillomavirus–associated oropharyngeal squamous cell carcinoma. Methods and Materials The major inclusion criteria were: ( 1 ) T0 to T3, N0 to N2c, M0; ( 2 ) human papillomavirus or p16 positive; and ( 3 ) minimal/remote smoking history. Treatment was limited to 60 Gy intensity modulated radiation thera...
116 CitationsSource
Cited By9
ABSTRACT In the past decade, dynamic contrast-enhanced magnetic resonance imaging has had an increasing role in assessing the microvascular characteristics of various tumors, including head and neck cancer. Dynamic contrast-enhanced magnetic resonance imaging allows noninvasive assessment of permeability and blood flow, both important parametric features of tumor hypoxia, which is in turn a marker for treatment resistance for head and neck cancer.In this article we will provide a comprehensive r...
#1Kyu Hye Choi (Catholic University of Korea)H-Index: 5
#2Jin Ho Song (Catholic University of Korea)H-Index: 11
Last. Yeon-Sil Kim (Catholic University of Korea)H-Index: 12
view all 9 authors...
BACKGROUND Positron-emission tomography (PET) is widely used to detect malignancies, but consensus on its prognostic value in oropharyngeal cancer has not been established. The purpose of this study was to analyze the PET parameters associated with tumor extent and survival in resectable oropharyngeal cancer. METHODS The PET parameters in oropharyngeal cancer patients with regional node metastasis who underwent surgery and postoperative radiotherapy between January 2005 and January 2019 were ana...
#1B.S. RosenH-Index: 7
#2J.R. WilkieH-Index: 3
Last. Michelle MierzwaH-Index: 15
view all 23 authors...
PURPOSE To assess associations between imaging biomarkers from standard of care pre-treatment CT and FDG-PET scans and locoregional (LR) and distant metastatic (DM) recurrences in patients with p16+ oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive chemoradiotherapy (CRT). METHODS An institutional database from a single NCI-designated cancer center identified 266 patients with p16+ OPSCC treated with definitive CRT in our department from 2005 to 2016 with evaluable pre-treatm...
#1Jim Zhong (Leeds Teaching Hospitals NHS Trust)H-Index: 5
#2R. Frood (Leeds Teaching Hospitals NHS Trust)H-Index: 6
Last. Andrew Scarsbrook (Leeds Teaching Hospitals NHS Trust)H-Index: 29
view all 9 authors...
AIM To determine whether machine learning-based radiomic feature analysis of baseline integrated 2-[18F]-fluoro-2-deoxy- d- glucose (FDG) positron-emission tomography (PET) computed tomography (CT) predicts disease progression in patients with locally advanced larynx and hypopharynx squamous cell carcinoma (SCC) receiving (chemo)radiotherapy. MATERIALS AND METHODS Patients with larynx and hypopharynx SCC treated with definitive (chemo)radiotherapy at a specialist cancer centre undergoing pre-tre...
#1Farshad Moradi (Stanford University)H-Index: 20
Metabolic reprogramming and avid fluorodeoxyglucose (FDG) uptake in locally advanced head and neck squamous cell carcinomas and other cancers of the upper aerodigestive tract lead to favorable sensitivity and diagnostic accuracy of FDG PET/CT or PET/MR compared to conventional imaging. Meanwhile, the role of non-FDG PET in head and neck malignancies is rapidly expanding. Accurate staging, identifying a clinically occult primary, or detection of distant metastasis or a synchronous malignancy on F...
#1Antonello VidiriH-Index: 24
#2Emma GangemiH-Index: 5
Last. Simona MarziH-Index: 18
view all 13 authors...
Objectives To investigate the correlation between histogram-based Dynamic Contrast-Enhanced magnetic resonance imaging (DCE-MRI) parameters and positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG-PET) values in oropharyngeal squamous cell carcinoma (OPSCC), both in primary tumors (PTs) and in metastatic lymph nodes (LNs). Methods 52 patients with a new pathologically-confirmed OPSCC were included in the present retrospective cohort study. Imaging including DCE-MRI and 18F-FDG PET/C...
2 CitationsSource
#1Tetsuro Sekine (Nippon Medical School)H-Index: 12
In current clinical practice, the standard approach for initial assessment of head and neck cancer (HNC) is clinical examination followed by neck ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Compared with these modalities, fluorodeoxyglucose (FDG)-positron emission tomography (PET) may provide unique information about metabolic characteristics. The abnormal elevation of FDG uptake has been shown to be specifically induced in tumor cells because of its low rate of d...
#1Yue Cao (UM: University of Michigan)H-Index: 43
#2Madhava P. Aryal (UM: University of Michigan)H-Index: 10
Last. Michelle Mierzwa (UM: University of Michigan)H-Index: 15
view all 15 authors...
Purpose: To investigate p16 effects on quantitative imaging (QI) metrics of MRI and FDG-PET and their response rates during radiation therapy as well as predictive values for local, regional and distant failure (LF, RF and DF) in poor prognosis locally advanced head and neck cancers (HNC). We hypothesized that MRI-based QI metrics could add to clinical predictors of treatment failure more significantly than FDG-PET metrics. Materials and methods: 54 patients with poor prognosis HNCs who were enr...
5 CitationsSource
#1J.M. Moan (Oslo University Hospital)H-Index: 3
#2Cecilie Delphin Amdal (Oslo University Hospital)H-Index: 7
Last. Einar Dale (Oslo University Hospital)H-Index: 6
view all 6 authors...
Abstract Background and purpose Standardized uptake value (SUV) and related parameters derived from 2-deoxy-2-[18F]-fluoro- d -glucose (FDG) PET/CT prior to radiochemotherapy of head and neck cancer (HNC) were significantly associated with survival in a number of studies. The aim of this study was to validate these findings and to evaluate the prognostic role of PET parameters also including clinical factors and HPV status. Materials and methods We reviewed 166 HNC cases with a radiotherapy plan...
8 CitationsSource