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Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck (LA-SCCHN)
Rudžianskas, V.; Korobeinikova, E.; Rudžianskienė, M.; Jaselskė, E.; Adlienė, D.; Šedienė, S.; Kulakienė, I.; Padervinskis, E.; Jurkienė, N.; Juozaitytė, E. Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Medicina2018, 54, 107.
Rudžianskas, V.; Korobeinikova, E.; Rudžianskienė, M.; Jaselskė, E.; Adlienė, D.; Šedienė, S.; Kulakienė, I.; Padervinskis, E.; Jurkienė, N.; Juozaitytė, E. Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Medicina 2018, 54, 107.
Rudžianskas, V.; Korobeinikova, E.; Rudžianskienė, M.; Jaselskė, E.; Adlienė, D.; Šedienė, S.; Kulakienė, I.; Padervinskis, E.; Jurkienė, N.; Juozaitytė, E. Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Medicina2018, 54, 107.
Rudžianskas, V.; Korobeinikova, E.; Rudžianskienė, M.; Jaselskė, E.; Adlienė, D.; Šedienė, S.; Kulakienė, I.; Padervinskis, E.; Jurkienė, N.; Juozaitytė, E. Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Medicina 2018, 54, 107.
Abstract
Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in LA-SCCHN. However, pre-ICT gross tumour volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT has an advantage of biological tumour information comparing to standard imaging methods, we aimed to evaluate the feasibility of 18F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUVmax, MTV and TLG in primary tumour and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progresses were localised in high-to-intermediate dose (60–70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUVmax ≥74% (p = 0.03), MTV ≥ 68% (p = 0.04), TLG ≥ 76% (p = 0.02) in primary tumour, and LN TLG decrease ≥74% (p = 0.03) were associated with PFS. Decrease of primary tumour SUVmax ≥ 74% (p = 0.04), MTV ≥ 69% (p = 0.04), TLG ≥ 74% (p = 0.02) and LN TLG ≥ 73% (p = 0.02) were prognostic factors for OS. Conclusions: According to our results, 18F-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impact on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUVmax, MTV and TLG has a prognostic value in LA-SCCHN.
Keywords
head and neck cancer; induction chemotherapy; 18F-FDG PET/CT; target volume delineation
Subject
Medicine and Pharmacology, Oncology and Oncogenics
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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