The Clinical Usefulness of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography (PET) to Predict Oncologic Outcomes and PET-Based Radiotherapeutic Considerations in Locally Advanced Nasopharyngeal Carcinoma.
- Author:
Hong In YOON
1
;
Kyung Hwan KIM
;
Jeongshim LEE
;
Yun Ho ROH
;
Mijin YUN
;
Byoung Chul CHO
;
Chang Geol LEE
;
Ki Chang KEUM
Author Information
- Publication Type:Original Article
- Keywords: Nasopharyngeal carcinoma; ¹⁸F-fluorodeoxyglucose; Positron emission tomography; Radiotherapy dosage; Intensity-modulated radiotherapy
- MeSH: Disease Progression; Disease-Free Survival; Electrons*; Glycolysis; Humans; Multivariate Analysis; Positron-Emission Tomography*; Prognosis; Radiotherapy; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Tumor Burden
- From:Cancer Research and Treatment 2016;48(3):928-941
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: We investigated ¹⁸F-fluorodeoxyglucose positron emission tomography (PET)-derived parameters as prognostic indices for disease progression and survival in locally advanced nasopharyngeal carcinoma (NPC) and the effect of high-dose radiotherapy for a subpopulation with PET-based poor prognoses. MATERIALS AND METHODS: Ninety-seven stage III and Iva-b NPC patients who underwent definitive treatment and PET were reviewed. For each primary, nodal, and whole tumor, maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) were evaluated. RESULTS: Based on the C-index (0.666) and incremental area under the curve (0.669), the whole tumor TLGwas the most useful predictorfor progression-free survival (PFS); thewhole tumor TLG cut-off value showing the best predictive performance was 322.7. In multivariate analysis, whole tumor TLG was a significant prognostic factor for PFS (hazard ratio [HR], 0.3; 95% confidence interval [CI], 0.14 to 0.65; p=0.002) and OS (HR, 0.29; 95% CI, 0.11 to 0.79; p=0.02). Patients with low whole tumor TLG showed the higher 5-year PFS in the subgroup for only patients receiving intensity modulated radiotherapy (77.4% vs. 53.0%, p=0.01). In the subgroup of patients with high whole tumor TLG, patients receiving an EQD₂≥ 70 Gy showed significantly greater complete remission rates (71.4% vs. 33.3%, p=0.03) and higher 5-year OS (74.7% vs. 19.6%, p=0.02). CONCLUSION: Our findings demonstrated that whole tumor TLG could be an independent prognostic factor and high-dose radiotherapy could improve outcomes for NPC showing high whole tumor TLG.
