Frontiers in Oncology (Jun 2022)

18F-Fluorodeoxyglucose Positron Emission Tomography of Head and Neck Cancer: Location and HPV Specific Parameters for Potential Treatment Individualization

  • Sebastian Zschaeck,
  • Sebastian Zschaeck,
  • Sebastian Zschaeck,
  • Sebastian Zschaeck,
  • Sebastian Zschaeck,
  • Julian Weingärtner,
  • Julian Weingärtner,
  • Elia Lombardo,
  • Sebastian Marschner,
  • Sebastian Marschner,
  • Marina Hajiyianni,
  • Marcus Beck,
  • Daniel Zips,
  • Daniel Zips,
  • Daniel Zips,
  • Yimin Li,
  • Qin Lin,
  • Holger Amthauer,
  • Esther G. C. Troost,
  • Esther G. C. Troost,
  • Esther G. C. Troost,
  • Esther G. C. Troost,
  • Esther G. C. Troost,
  • Esther G. C. Troost,
  • Esther G. C. Troost,
  • Jörg van den Hoff,
  • Volker Budach,
  • Jörg Kotzerke,
  • Jörg Kotzerke,
  • Jörg Kotzerke,
  • Konstantinos Ferentinos,
  • Efstratios Karagiannis,
  • David Kaul,
  • Vincent Gregoire,
  • Adrien Holzgreve,
  • Nathalie L. Albert,
  • Pavel Nikulin,
  • Michael Bachmann,
  • Klaus Kopka,
  • Mechthild Krause,
  • Mechthild Krause,
  • Mechthild Krause,
  • Mechthild Krause,
  • Mechthild Krause,
  • Mechthild Krause,
  • Mechthild Krause,
  • Michael Baumann,
  • Michael Baumann,
  • Michael Baumann,
  • Michael Baumann,
  • Michael Baumann,
  • Joanna Kazmierska,
  • Joanna Kazmierska,
  • Paulina Cegla,
  • Witold Cholewinski,
  • Witold Cholewinski,
  • Iosif Strouthos,
  • Klaus Zöphel,
  • Klaus Zöphel,
  • Klaus Zöphel,
  • Klaus Zöphel,
  • Ewa Majchrzak,
  • Guillaume Landry,
  • Claus Belka,
  • Claus Belka,
  • Carmen Stromberger,
  • Frank Hofheinz

DOI
https://doi.org/10.3389/fonc.2022.870319
Journal volume & issue
Vol. 12

Abstract

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Purpose18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is utilized for staging and treatment planning of head and neck squamous cell carcinomas (HNSCC). Some older publications on the prognostic relevance showed inconclusive results, most probably due to small study sizes. This study evaluates the prognostic and potentially predictive value of FDG-PET in a large multi-center analysis.MethodsOriginal analysis of individual FDG-PET and patient data from 16 international centers (8 institutional datasets, 8 public repositories) with 1104 patients. All patients received curative intent radiotherapy/chemoradiation (CRT) and pre-treatment FDG-PET imaging. Primary tumors were semi-automatically delineated for calculation of SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Cox regression analyses were performed for event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM).ResultsFDG-PET parameters were associated with patient outcome in the whole cohort regarding clinical endpoints (EFS, OS, LRC, FFDM), in uni- and multivariate Cox regression analyses. Several previously published cut-off values were successfully validated. Subgroup analyses identified tumor- and human papillomavirus (HPV) specific parameters. In HPV positive oropharynx cancer (OPC) SUVmax was well suited to identify patients with excellent LRC for organ preservation. Patients with SUVmax of 14 or less were unlikely to develop loco-regional recurrence after definitive CRT. In contrast FDG PET parameters deliver only limited prognostic information in laryngeal cancer.ConclusionFDG-PET parameters bear considerable prognostic value in HNSCC and potential predictive value in subgroups of patients, especially regarding treatment de-intensification and organ-preservation. The potential predictive value needs further validation in appropriate control groups. Further research on advanced imaging approaches including radiomics or artificial intelligence methods should implement the identified cut-off values as benchmark routine imaging parameters.

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