nach oben

European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

21.08.2018 | Original Article

PET-based prognostic survival model after radiotherapy for head and neck cancer

verfasst von: Joël Castelli, A. Depeursinge, A. Devillers, B. Campillo-Gimenez, Y. Dicente, J. O. Prior, E. Chajon, F. Jegoux, C. Sire, O. Acosta, E. Gherga, X. Sun, B. De Bari, J. Bourhis, R. de Crevoisier

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aims of this multicentre retrospective study of locally advanced head and neck cancer (LAHNC) treated with definitive radiotherapy were to (1) identify positron emission tomography (PET)-¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) parameters correlated with overall survival (OS) in a training cohort, (2) compute a prognostic model, and (3) externally validate this model in an independent cohort.

Materials and methods

A total of 237 consecutive LAHNC patients divided into training (n = 127) and validation cohorts (n = 110) were retrospectively analysed. The following PET parameters were analysed: SUV_Max, metabolic tumour volume (MTV), total lesion glycolysis (TLG), and SUV_Mean for the primary tumour and lymph nodes using a relative SUV_Max threshold or an absolute SUV threshold. Cox analyses were performed on OS in the training cohort. The c-index was used to identify the highly prognostic parameters. A prognostic model was subsequently identified, and a nomogram was generated. The model was externally tested in the validation cohort.

Results

In univariate analysis, the significant PET parameters for the primary tumour included MTV (relative thresholds from 6 to 83% and absolute thresholds from 1.5 to 6.5) and TLG (relative thresholds from 1 to 82% and absolute thresholds from 0.5 to 4.5). For the lymph nodes, the significant parameters included MTV and TLG regardless of the threshold value. In multivariate analysis, tumour site, p16 status, MTV35% of the primary tumour, and MTV44% of the lymph nodes were independent predictors of OS. Based on these four parameters, a prognostic model was identified with a c-index of 0.72. The corresponding nomogram was generated. This prognostic model was externally validated, achieving a c-index of 0.66.

Conclusions

A prognostic model of OS based on primary tumour and lymph node MTV, tumour site, and p16 status was proposed and validated. The corresponding nomogram may be used to tailor individualized treatment.

Nur mit Berechtigung zugänglich

Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4. https://doi.org/10.1245/s10434-010-0985-4.CrossRefPubMed

Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet. 2000;355:949–55.CrossRefPubMed

Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350:1945–52. https://doi.org/10.1056/NEJMoa032641.CrossRefPubMed

Bourhis J, Sire C, Graff P, Gregoire V, Maingon P, Calais G, et al. Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99-02): an open-label phase 3 randomised trial. Lancet Oncol. 2012;13:145–53. https://doi.org/10.1016/s1470-2045(11)70346-1.CrossRefPubMed

Bonner JA, Harari PM, Giralt J, Cohen RB, Jones CU, Sur RK, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010;11:21–8. https://doi.org/10.1016/s1470-2045(09)70311-0.CrossRefPubMed

Chajon E, Lafond C, Louvel G, Castelli J, Williaume D, Henry O, et al. Salivary gland-sparing other than parotid-sparing in definitive head-and-neck intensity-modulated radiotherapy does not seem to jeopardize local control. Radiat Oncol. 2013;8:132. https://doi.org/10.1186/1748-717x-8-132.CrossRefPubMedPubMedCentral

Schwartz DL, Harris J, Yao M, Rosenthal DI, Opanowski A, Levering A, et al. Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer: pilot results from radiation therapy oncology group protocol 0522. Int J Radiat Oncol Biol Phys. 2015;91:721–9. https://doi.org/10.1016/j.ijrobp.2014.12.023.CrossRefPubMedPubMedCentral

Moon SH, Choi JY, Lee HJ, Son YI, Baek CH, Ahn YC, et al. Prognostic value of volume-based positron emission tomography/computed tomography in patients with nasopharyngeal carcinoma treated with concurrent chemoradiotherapy. Clin Exp Otorhinolaryngol. 2015;8:142–8. https://doi.org/10.3342/ceo.2015.8.2.142.CrossRefPubMedPubMedCentral

Cacicedo J, Navarro A, Del Hoyo O, Gomez-Iturriaga A, Alongi F, Medina JA, et al. Role of [18F] fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol. 2016;89:20160217. https://doi.org/10.1259/bjr.20160217.CrossRefPubMedPubMedCentral

10.

Castelli J, Depeursinge A, de Bari B, Devillers A, de Crevoisier R, Bourhis J, et al. Metabolic tumor volume and total lesion glycolysis in oropharyngeal cancer treated with definitive radiotherapy: which threshold is the best predictor of local control? Clin Nucl Med. 2017;42:e281–e5. https://doi.org/10.1097/rlu.0000000000001614.CrossRefPubMed

11.

Schinagl DA, Span PN, Oyen WJ, Kaanders JH. Can FDG PET predict radiation treatment outcome in head and neck cancer? Results of a prospective study. Eur J Nucl Med Mol Imaging. 2011;38:1449–58. https://doi.org/10.1007/s00259-011-1789-x.CrossRefPubMedPubMedCentral

12.

Kao CH, Lin SC, Hsieh TC, Yen KY, Yang SN, Wang YC, et al. Use of pretreatment metabolic tumour volumes to predict the outcome of pharyngeal cancer treated by definitive radiotherapy. Eur J Nucl Med Mol Imaging. 2012;39:1297–305. https://doi.org/10.1007/s00259-012-2127-7.CrossRefPubMed

13.

Cheng NM, Fang YH, Lee LY, Chang JT, Tsan DL, Ng SH, et al. Zone-size nonuniformity of 18F-FDG PET regional textural features predicts survival in patients with oropharyngeal cancer. Eur J Nucl Med Mol Imaging. 2015;42:419–28. https://doi.org/10.1007/s00259-014-2933-1.CrossRefPubMed

14.

Lin YC, Chen SW, Hsieh TC, Yen KY, Yang SN, Wang YC, et al. Risk stratification of metastatic neck nodes by CT and PET in patients with head and neck cancer receiving definitive radiotherapy. J Nucl Med. 2015;56:183–9. https://doi.org/10.2967/jnumed.114.148023.CrossRefPubMed

15.

Yabuki K, Shiono O, Komatsu M, Sano D, Nishimura G, Takahashi M, et al. Predictive and prognostic value of metabolic tumor volume (MTV) in patients with laryngeal carcinoma treated by radiotherapy (RT) /concurrent chemoradiotherapy (CCRT). PLoS One. 2015;10:e0117924. https://doi.org/10.1371/journal.pone.0117924.CrossRefPubMedPubMedCentral

16.

Abgral R, Keromnes N, Robin P, Le Roux PY, Bourhis D, Palard X, et al. Prognostic value of volumetric parameters measured by 18F-FDG PET/CT in patients with head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2014;41:659–67. https://doi.org/10.1007/s00259-013-2618-1.CrossRefPubMed

17.

Abgral R, Valette G, Robin P, Rousset J, Keromnes N, Le Roux PY, et al. Prognostic evaluation of percentage variation of metabolic tumor burden calculated by dual-phase (18) FDG PET-CT imaging in patients with head and neck cancer. Head Neck. 2016; 38(Suppl 1:E600-6. https://doi.org/10.1002/hed.24048.CrossRefPubMed

18.

Park GC, Kim JS, Roh JL, Choi SH, Nam SY, Kim SY. Prognostic value of metabolic tumor volume measured by 18F-FDG PET/CT in advanced-stage squamous cell carcinoma of the larynx and hypopharynx. Ann Oncol. 2013;24:208–14. https://doi.org/10.1093/annonc/mds247.CrossRefPubMed

19.

Mohan R, Wu Q, Manning M, Schmidt-Ullrich R. Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. Int J Radiat Oncol Biol Phys. 2000;46:619–30.CrossRefPubMed

20.

Lee N, Chuang C, Quivey JM, Phillips TL, Akazawa P, Verhey LJ, et al. Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys. 2002;53:630–7.CrossRefPubMed

21.

Dicente Cid Y, Castelli J, Schaer R, Scher N, Pomoni A, Prior JO, et al. Chapter 12 — Quantimage: an online tool for high-throughput 3D radiomics feature extraction in PET-CT. In: Depeursinge A, Al-Kadi OS, Mitchell JR (Eds) Biomedical texture analysis: London, Academic; 2017. pp 349-77.

22.

Schemper M, Smith TL. A note on quantifying follow-up in studies of failure time. Control Clin Trials. 1996;17:343–6.CrossRefPubMed

23.

Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Br J Cancer. 2015;112:251–9. https://doi.org/10.1038/bjc.2014.639.CrossRefPubMedPubMedCentral

24.

Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87. https://doi.org/10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4.CrossRefPubMed

25.

Efron B, Gong G. A leisurely look at the bootstrap, the jackknife, and cross-validation. Am Stat. 1983;37:36–48. https://doi.org/10.2307/2685844.CrossRef

26.

Castelli J, De Bari B, Depeursinge A, Simon A, Devillers A, Roman Jimenez G, et al. Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy. Crit Rev Oncol Hematol. 2016;108:40–51. https://doi.org/10.1016/j.critrevonc.2016.10.009.CrossRefPubMed

27.

Bonomo P, Merlotti A, Olmetto E, Bianchi A, Desideri I, Bacigalupo A, et al. What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2018. https://doi.org/10.1007/s00259-018-4065-5.

28.

Apostolova I, Steffen IG, Wedel F, Lougovski A, Marnitz S, Derlin T, et al. Asphericity of pretherapeutic tumour FDG uptake provides independent prognostic value in head-and-neck cancer. Eur Radiol. 2014;24:2077–87. https://doi.org/10.1007/s00330-014-3269-8.CrossRefPubMed

29.

Castelli J, Depeursinge A, Ndoh V, Prior JO, Ozsahin M, Devillers A, et al. A PET-based nomogram for oropharyngeal cancers. Eur J Cancer. 2017;75:222–30. https://doi.org/10.1016/j.ejca.2017.01.018.CrossRefPubMed

30.

Tang C, Murphy JD, Khong B, La TH, Kong C, Fischbein NJ, et al. Validation that metabolic tumor volume predicts outcome in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2012;83:1514–20. https://doi.org/10.1016/j.ijrobp.2011.10.023.CrossRefPubMedPubMedCentral

31.

Hofheinz F, Lougovski A, Zophel K, Hentschel M, Steffen IG, Apostolova I, et al. Increased evidence for the prognostic value of primary tumor asphericity in pretherapeutic FDG PET for risk stratification in patients with head and neck cancer. Eur J Nucl Med Mol Imaging. 2015;42:429–37. https://doi.org/10.1007/s00259-014-2953-x.CrossRefPubMed

32.

Royston P, Altman DG. External validation of a Cox prognostic model: principles and methods. BMC Med Res Methodol. 2013;13:33. https://doi.org/10.1186/1471-2288-13-33.CrossRefPubMedPubMedCentral

33.

Murphy JD, La TH, Chu K, Quon A, Fischbein NJ, Maxim PG, et al. Postradiation metabolic tumor volume predicts outcome in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2011;80:514–21. https://doi.org/10.1016/j.ijrobp.2010.01.057.CrossRefPubMed

34.

Moon SH, Choi JY, Lee HJ, Son YI, Baek CH, Ahn YC, et al. Prognostic value of 18F-FDG PET/CT in patients with squamous cell carcinoma of the tonsil: comparisons of volume-based metabolic parameters. Head Neck. 2013;35:15–22. https://doi.org/10.1002/hed.22904.CrossRefPubMed

35.

Castelli J, Depeursinge A, de Bari B, Devillers A, de Crevoisier R, Bourhis J, et al. Metabolic tumor volume and total lesion glycolysis in oropharyngeal cancer treated with definitive radiotherapy: which threshold is the best predictor of local control? Clin Nucl Med. 2017;42(6):e281–e285. https://doi.org/10.1097/RLU.0000000000001614.CrossRefPubMed

36.

Akagunduz OO, Savas R, Yalman D, Kocacelebi K, Esassolak M. Can adaptive threshold-based metabolic tumor volume (MTV) and lean body mass corrected standard uptake value (SUL) predict prognosis in head and neck cancer patients treated with definitive radiotherapy/chemoradiotherapy? Nucl Med Biol. 2015;42:899–904. https://doi.org/10.1016/j.nucmedbio.2015.06.007.CrossRefPubMed

37.

Cheng NM, Fang YH, Chang JT, Huang CG, Tsan DL, Ng SH, et al. Textural features of pretreatment 18F-FDG PET/CT images: prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma. J Nucl Med. 2013;54:1703–9. https://doi.org/10.2967/jnumed.112.119289.CrossRefPubMed

38.

Hanamoto A, Tatsumi M, Takenaka Y, Hamasaki T, Yasui T, Nakahara S, et al. Volumetric PET/CT parameters predict local response of head and neck squamous cell carcinoma to chemoradiotherapy. Cancer Med. 2014;3:1368–76. https://doi.org/10.1002/cam4.295.CrossRefPubMedPubMedCentral

39.

Hentschel M, Appold S, Schreiber A, Abolmaali N, Abramyuk A, Dorr W, et al. Early FDG PET at 10 or 20 Gy under chemoradiotherapy is prognostic for locoregional control and overall survival in patients with head and neck cancer. Eur J Nucl Med Mol Imaging. 2011;38:1203–11. https://doi.org/10.1007/s00259-011-1759-3.CrossRefPubMed

40.

Alluri KC, Tahari AK, Wahl RL, Koch W, Chung CH, Subramaniam RM. Prognostic value of FDG PET metabolic tumor volume in human papillomavirus-positive stage III and IV oropharyngeal squamous cell carcinoma. AJR Am J Roentgenol. 2014;203:897–903. https://doi.org/10.2214/AJR.14.12497.CrossRefPubMedPubMedCentral

41.

Lin P, Min M, Lee M, Holloway L, Forstner D, Bray V, et al. Nodal parameters of FDG PET/CT performed during radiotherapy for locally advanced mucosal primary head and neck squamous cell carcinoma can predict treatment outcomes: SUVmean and response rate are useful imaging biomarkers. Eur J Nucl Med Mol Imaging. 2017;44(5):801-811 https://doi.org/10.1007/s00259-016-3584-1.CrossRefPubMed

42.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47. https://doi.org/10.1016/j.ejca.2008.10.026.CrossRefPubMed

43.

Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomark Prev. 2005;14:467–75. https://doi.org/10.1158/1055-9965.EPI-04-0551.CrossRef

44.

Mehanna H, Beech T, Nicholson T, El-Hariry I, McConkey C, Paleri V, et al. Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer--systematic review and meta-analysis of trends by time and region. Head Neck. 2013;35:747–55. https://doi.org/10.1002/hed.22015.CrossRefPubMed

45.

Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363:24–35. https://doi.org/10.1056/NEJMoa0912217.CrossRefPubMedPubMedCentral

46.

Kendi AT, Magliocca K, Corey A, Nickleach DC, Galt J, Higgins K, et al. Do 18F-FDG PET/CT parameters in oropharyngeal and oral cavity squamous cell carcinomas indicate HPV status? Clin Nucl Med. 2015;40:e196–200. https://doi.org/10.1097/rlu.0000000000000691.CrossRefPubMedPubMedCentral

47.

Brizel DM, Sibley GS, Prosnitz LR, Scher RL, Dewhirst MW. Tumor hypoxia adversely affects the prognosis of carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 1997;38:285–9.CrossRefPubMed

48.

Graves EE, Hicks RJ, Binns D, Bressel M, Le Q-T, Peters L, et al. Quantitative and qualitative analysis of [(18)F] FDG and [(18)F] FAZA positron emission tomography of head and neck cancers and associations with HPV status and treatment outcome. Eur J Nucl Med Mol Imaging. 2016;43:617–25. https://doi.org/10.1007/s00259-015-3247-7.CrossRefPubMed

49.

Beck R, Roper B, Carlsen JM, Huisman MC, Lebschi JA, Andratschke N, et al. Pretreatment 18F-FAZA PET predicts success of hypoxia-directed radiochemotherapy using tirapazamine. J Nucl Med. 2007;48:973–80. https://doi.org/10.2967/jnumed.106.038570.CrossRefPubMed

50.

Thorwarth D, Eschmann SM, Holzner F, Paulsen F, Alber M. Combined uptake of [18F] FDG and [18F] FMISO correlates with radiation therapy outcome in head-and-neck cancer patients. Radiother Oncol. 2006;80:151–6. https://doi.org/10.1016/j.radonc.2006.07.033.CrossRefPubMed

51.

Kikuchi M, Koyasu S, Shinohara S, Usami Y, Imai Y, Hino M, et al. Prognostic value of pretreatment 18F-fluorodeoxyglucose positron emission tomography/CT volume-based parameters in patients with oropharyngeal squamous cell carcinoma with known p16 and p53 status. Head Neck. 2015;37:1524–31. https://doi.org/10.1002/hed.23784.CrossRefPubMed

52.

Romesser PB, Qureshi MM, Shah BA, Chatburn LT, Jalisi S, Devaiah AK, et al. Superior prognostic utility of gross and metabolic tumor volume compared to standardized uptake value using PET/CT in head and neck squamous cell carcinoma patients treated with intensity-modulated radiotherapy. Ann Nucl Med. 2012;26:527–34. https://doi.org/10.1007/s12149-012-0604-5.CrossRefPubMedPubMedCentral

53.

Arens AI, Troost EG, Hoeben BA, Grootjans W, Lee JA, Gregoire V, et al. Semiautomatic methods for segmentation of the proliferative tumour volume on sequential FLT PET/CT images in head and neck carcinomas and their relation to clinical outcome. Eur J Nucl Med Mol Imaging. 2014;41:915–24. https://doi.org/10.1007/s00259-013-2651-0.CrossRefPubMed

54.

Kaalep A, Sera T, Oyen W, Krause BJ, Chiti A, Liu Y, et al. EANM/EARL FDG-PET/CT accreditation — summary results from the first 200 accredited imaging systems. Eur J Nucl Med Mol Imaging. 2018;45:412–22. https://doi.org/10.1007/s00259-017-3853-7.CrossRefPubMed

55.

Brun E, Kjellen E, Tennvall J, Ohlsson T, Sandell A, Perfekt R, et al. FDG PET studies during treatment: prediction of therapy outcome in head and neck squamous cell carcinoma. Head Neck. 2002;24:127–35.CrossRefPubMed

56.

Chen SW, Hsieh TC, Yen KY, Yang SN, Wang YC, Chien CR, et al. Interim FDG PET/CT for predicting the outcome in patients with head and neck cancer. Laryngoscope. 2014;124:2732–8. https://doi.org/10.1002/lary.24826.CrossRefPubMed

57.

Min M, Lin P, Lee MT, Shon IH, Lin M, Forstner D, et al. Prognostic role of metabolic parameters of (18)F-FDG PET-CT scan performed during radiation therapy in locally advanced head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2015;42:1984–94. https://doi.org/10.1007/s00259-015-3104-8.CrossRefPubMedPubMedCentral

58.

Leijenaar RT, Carvalho S, Hoebers FJ, Aerts HJ, van Elmpt WJ, Huang SH, et al. External validation of a prognostic CT-based radiomic signature in oropharyngeal squamous cell carcinoma. Acta Oncol. 2015;54:1423–9. https://doi.org/10.3109/0284186x.2015.1061214.CrossRefPubMed

59.

Min M, Lin P, Liney G, Lee M, Forstner D, Fowler A, et al. A review of the predictive role of functional imaging in patients with mucosal primary head and neck cancer treated with radiation therapy. J Med Imaging Radiat Oncol. 2017;61:99–123. https://doi.org/10.1111/1754-9485.12496.CrossRefPubMed

Titel: PET-based prognostic survival model after radiotherapy for head and neck cancer
verfasst von: Joël Castelli
A. Depeursinge
A. Devillers
B. Campillo-Gimenez
Y. Dicente
J. O. Prior
E. Chajon
F. Jegoux
C. Sire
O. Acosta
E. Gherga
X. Sun
B. De Bari
J. Bourhis
R. de Crevoisier
Publikationsdatum: 21.08.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 3/2019
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4134-9

Springer Medizin

Abstract

Purpose

Materials and methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2019

Safety and efficacy of targeted alpha therapy with 213Bi-DOTA-substance P in recurrent glioblastoma

The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma

Region-by-region analysis of PET, MRI, and histology in en bloc-resected oligodendrogliomas reveals intra-tumoral heterogeneity

Feasibility of multi-parametric PET and MRI for prediction of tumour recurrence in patients with glioblastoma

Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis

Transarterial radioembolization in patients with hepatocellular carcinoma of intermediate B2 substage