PLoS ONE (Jan 2018)

Early metabolic 18F-FDG PET/CT response of locally advanced squamous-cell carcinoma of head and neck to induction chemotherapy: A prospective pilot study.

  • Ulisses Ribaldo Nicolau,
  • Victor Hugo Fonseca de Jesus,
  • Eduardo Nóbrega Pereira Lima,
  • Marclesson Santos Alves,
  • Thiago Bueno de Oliveira,
  • Louise De Brot Andrade,
  • Virgilio Souza Silva,
  • Paula Cacciatore Bes,
  • Tadeu Ferreira de Paiva,
  • Vinicius Fernando Calsavara,
  • Andrea Paiva Gadelha Guimarães,
  • Loureno Cezana,
  • Paula Nicole Vieira Pinto Barbosa,
  • Gislaine Cristina Lopes Machado Porto,
  • Antônio Cássio Assis Pellizzon,
  • Genival Barbosa de Carvalho,
  • Luiz Paulo Kowalski

DOI
https://doi.org/10.1371/journal.pone.0200823
Journal volume & issue
Vol. 13, no. 8
p. e0200823

Abstract

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OBJECTIVE:The objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN). METHODS AND FINDINGS:A prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA-B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056-0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040-0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062-0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013-0.96; p = 0.046) survival. CONCLUSIONS:These results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes.