Skip to main content
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 5/2020

10.02.2020 | Original Article

Quantification of 18F-fluorodeoxyglucose uptake to detect residual nodal disease in locally advanced head and neck squamous cell carcinoma after chemoradiotherapy: results from the ECLYPS study

verfasst von: Nils Helsen, Tim Van den Wyngaert, Laurens Carp, Remco De Bree, Olivier M. VanderVeken, Frank De Geeter, Alex Maes, Jean-Philippe Cambier, Karoline Spaepen, Michel Martens, Sara Hakim, Laurence Beels, Otto S. Hoekstra, Danielle Van den Weyngaert, Sigrid Stroobants, Carl Van Laer, Pol Specenier, Annelies Maes, Philip Debruyne, Isabel Hutsebaut, Joost Van Dinter, Filip Homans, Laurence Goethals, Oliver Lenssen, Kristof Deben, ECLYPS Consortium

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed.

Methods

SUVbody weight thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127).

Results

In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV70 threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-to-background ratios, an SUV50/SUVliver threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV70 and SUV50/SUVliver provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV70 = 0.93, SUV50/SUVliver = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant).

Conclusion

FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV70 threshold 2.2) prove robust, yet ratios (SUV50/SUVliver, threshold 0.96) may be more useful in routine clinical care. In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria.

Trial registration

US National Library for Medicine, NCT01179360. Registered 11 August 2010, https://​clinicaltrials.​gov/​ct2/​show/​NCT01179360
Anhänge
Nur mit Berechtigung zugänglich
Literatur
2.
Zurück zum Zitat Clayman G, Johnson C 2nd, Morrison W, Ginsberg L, Lippman S. The role of neck dissection after chemoradiotherapy for oropharyngeal cancer with advanced nodal disease. Arch Otolaryngol Head Neck Surg. 2001;127:135–9.CrossRef Clayman G, Johnson C 2nd, Morrison W, Ginsberg L, Lippman S. The role of neck dissection after chemoradiotherapy for oropharyngeal cancer with advanced nodal disease. Arch Otolaryngol Head Neck Surg. 2001;127:135–9.CrossRef
3.
Zurück zum Zitat Frank D, Hu K, Culliney B, Persky M, Nussbaum M, Schantz S, et al. Planned neck dissection after concomitant radiochemotherapy for advanced head and neck cancer. Laryngoscope. 2005;115:1015–20.CrossRef Frank D, Hu K, Culliney B, Persky M, Nussbaum M, Schantz S, et al. Planned neck dissection after concomitant radiochemotherapy for advanced head and neck cancer. Laryngoscope. 2005;115:1015–20.CrossRef
4.
Zurück zum Zitat Brizel D, Prosnitz R, Hunter S, Fisher S, Clough R, Downe M, et al. Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004;58. Brizel D, Prosnitz R, Hunter S, Fisher S, Clough R, Downe M, et al. Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004;58.
5.
Zurück zum Zitat Gupta T, Master Z, Kannan S, Agarwal JP, Ghsoh-Laskar S, Rangarajan V, et al. Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2011:2083–95. Gupta T, Master Z, Kannan S, Agarwal JP, Ghsoh-Laskar S, Rangarajan V, et al. Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2011:2083–95.
6.
Zurück zum Zitat Isles MG, McConkey C, Mehanna HM. A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol. 2008;33:210–22.CrossRef Isles MG, McConkey C, Mehanna HM. A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol. 2008;33:210–22.CrossRef
7.
Zurück zum Zitat Helsen N, Van den Wyngaert T, Carp L, Stroobants S. FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance. Eur J Nucl Med Mol Imaging. Germany; 2018; Helsen N, Van den Wyngaert T, Carp L, Stroobants S. FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance. Eur J Nucl Med Mol Imaging. Germany; 2018;
8.
Zurück zum Zitat Rodrigues RS, Bozza FA, Christian PE, Hoffman JM, Butterfield RI, Christensen CR, et al. Comparison of whole-body PET/CT, dedicated high-resolution head and neck PET/CT, and contrast-enhanced CT in preoperative staging of clinically M0 squamous cell carcinoma of the head and neck. J Nucl Med. 2009;50:1205–13.CrossRef Rodrigues RS, Bozza FA, Christian PE, Hoffman JM, Butterfield RI, Christensen CR, et al. Comparison of whole-body PET/CT, dedicated high-resolution head and neck PET/CT, and contrast-enhanced CT in preoperative staging of clinically M0 squamous cell carcinoma of the head and neck. J Nucl Med. 2009;50:1205–13.CrossRef
9.
Zurück zum Zitat Yamamoto Y, Wong TZ, Turkington TG, Hawk TC, Coleman RE. Head and neck cancer: dedicated FDG PET/CT protocol for detection--phantom and initial clinical studies. Radiology. 2007;244:263–72.CrossRef Yamamoto Y, Wong TZ, Turkington TG, Hawk TC, Coleman RE. Head and neck cancer: dedicated FDG PET/CT protocol for detection--phantom and initial clinical studies. Radiology. 2007;244:263–72.CrossRef
10.
Zurück zum Zitat Mehanna H, Wong W-L, McConkey CC, Rahman JK, Robinson M, Hartley AG, et al. PET-CT surveillance versus neck dissection in advanced head and neck Cancer. N Engl J Med. 2016;374:1444–54.CrossRef Mehanna H, Wong W-L, McConkey CC, Rahman JK, Robinson M, Hartley AG, et al. PET-CT surveillance versus neck dissection in advanced head and neck Cancer. N Engl J Med. 2016;374:1444–54.CrossRef
11.
Zurück zum Zitat Porceddu SV, Jarmolowski E, Hicks RJ, Ware R, Weih L, Rischin D, et al. Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo) radiotherapy in head and neck cancer. Head Neck. 2005;27:175–81.CrossRef Porceddu SV, Jarmolowski E, Hicks RJ, Ware R, Weih L, Rischin D, et al. Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo) radiotherapy in head and neck cancer. Head Neck. 2005;27:175–81.CrossRef
12.
Zurück zum Zitat Prestwich RJ, Subesinghe M, Gilbert A, Chowdhury FU, Sen M, Scarsbrook AF. Delayed response assessment with FDG-PET-CT following (chemo) radiotherapy for locally advanced head and neck squamous cell carcinoma. Clin Radiol. 2012;67:966–75.CrossRef Prestwich RJ, Subesinghe M, Gilbert A, Chowdhury FU, Sen M, Scarsbrook AF. Delayed response assessment with FDG-PET-CT following (chemo) radiotherapy for locally advanced head and neck squamous cell carcinoma. Clin Radiol. 2012;67:966–75.CrossRef
13.
Zurück zum Zitat Gupta T, Jain S, Agarwal JP, Rangarajan V, Purandare N, Ghosh-Laskar S, et al. Diagnostic performance of response assessment FDG-PET/CT in patients with head and neck squamous cell carcinoma treated with high-precision definitive (chemo)radiation. Radiother Oncol. 2010;97:194–9.CrossRef Gupta T, Jain S, Agarwal JP, Rangarajan V, Purandare N, Ghosh-Laskar S, et al. Diagnostic performance of response assessment FDG-PET/CT in patients with head and neck squamous cell carcinoma treated with high-precision definitive (chemo)radiation. Radiother Oncol. 2010;97:194–9.CrossRef
14.
Zurück zum Zitat Chan JYK, Sanguineti G, Richmon JD, Marur S, Gourin CG, Koch W, et al. Retrospective review of positron emission tomography with contrast-enhanced computed tomography in the posttreatment setting in human papillomavirus-associated oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2012;138:1040–6.CrossRef Chan JYK, Sanguineti G, Richmon JD, Marur S, Gourin CG, Koch W, et al. Retrospective review of positron emission tomography with contrast-enhanced computed tomography in the posttreatment setting in human papillomavirus-associated oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2012;138:1040–6.CrossRef
15.
Zurück zum Zitat Moeller BJ, Rana V, Cannon BA, Williams MD, Sturgis EM, Ginsberg LE, et al. Prospective risk-adjusted [18F] fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. J Clin Oncol. 2009;27:2509–15.CrossRef Moeller BJ, Rana V, Cannon BA, Williams MD, Sturgis EM, Ginsberg LE, et al. Prospective risk-adjusted [18F] fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. J Clin Oncol. 2009;27:2509–15.CrossRef
16.
Zurück zum Zitat Zundel MT, Michel MA, Schultz CJ, Maheshwari M, Wong SJ, Campbell BH, et al. Comparison of physical examination and fluorodeoxyglucose positron emission tomography/computed tomography 4–6 months after radiotherapy to assess residual head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2011;81:825–32.CrossRef Zundel MT, Michel MA, Schultz CJ, Maheshwari M, Wong SJ, Campbell BH, et al. Comparison of physical examination and fluorodeoxyglucose positron emission tomography/computed tomography 4–6 months after radiotherapy to assess residual head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2011;81:825–32.CrossRef
17.
Zurück zum Zitat Marcus C, Ciarallo A, Tahari AK, Mena E, Koch W, Wahl RL, et al. Head and neck PET/CT: therapy response interpretation criteria (Hopkins criteria)-interreader reliability, accuracy, and survival outcomes. J Nucl Med. 2014;55:1411–6.CrossRef Marcus C, Ciarallo A, Tahari AK, Mena E, Koch W, Wahl RL, et al. Head and neck PET/CT: therapy response interpretation criteria (Hopkins criteria)-interreader reliability, accuracy, and survival outcomes. J Nucl Med. 2014;55:1411–6.CrossRef
18.
Zurück zum Zitat Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.PubMed Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.PubMed
19.
Zurück zum Zitat Van Den Wyngaert T, Helsen N, Carp L, Hakim S, Martens MJ, Hutsebaut I, et al. Fluorodeoxyglucose-positron emission tomography/computed tomography after concurrent chemoradiotherapy in locally advanced head-and-neck squamous cell cancer: the ECLYPS study. J Clin Oncol. 2017;35. Van Den Wyngaert T, Helsen N, Carp L, Hakim S, Martens MJ, Hutsebaut I, et al. Fluorodeoxyglucose-positron emission tomography/computed tomography after concurrent chemoradiotherapy in locally advanced head-and-neck squamous cell cancer: the ECLYPS study. J Clin Oncol. 2017;35.
21.
Zurück zum Zitat Boellaard R, Oyen WJG, Hoekstra CJ, Hoekstra OS, Visser EP, Willemsen AT, et al. The Netherlands protocol for standardisation and quantification of FDG whole body PET studies in multi-Centre trials. Eur J Nucl Med Mol Imaging. 2008;35:2320–33.CrossRef Boellaard R, Oyen WJG, Hoekstra CJ, Hoekstra OS, Visser EP, Willemsen AT, et al. The Netherlands protocol for standardisation and quantification of FDG whole body PET studies in multi-Centre trials. Eur J Nucl Med Mol Imaging. 2008;35:2320–33.CrossRef
22.
Zurück zum Zitat Helsen N, Roothans D, Van Den Heuvel B, Van Den Wyngaert T, Van Den Weyngaert D, Carp L, et al. 18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy. PLoS One. 2017;12. Helsen N, Roothans D, Van Den Heuvel B, Van Den Wyngaert T, Van Den Weyngaert D, Carp L, et al. 18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy. PLoS One. 2017;12.
23.
Zurück zum Zitat Blanche P, Dartiques J, Jacqmin-Gadda H. Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks. Stat Med. 2013;32:5381–97.CrossRef Blanche P, Dartiques J, Jacqmin-Gadda H. Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks. Stat Med. 2013;32:5381–97.CrossRef
24.
Zurück zum Zitat Heagerty P, Lumley T, Pepe M. Time-dependent ROC curves for censored survival data and a diagnostic marker. Biometrics. 2000;56:337–44.CrossRef Heagerty P, Lumley T, Pepe M. Time-dependent ROC curves for censored survival data and a diagnostic marker. Biometrics. 2000;56:337–44.CrossRef
25.
Zurück zum Zitat Lapela M, Eigtved A, Jyrkkiö S, Grénman R, Kurki T, Lindholm P, et al. Experience in qualitative and quantitative FDG PET in follow-up of patients with suspected recurrence from head and neck cancer. Eur J Cancer. 2000;36:858–67.CrossRef Lapela M, Eigtved A, Jyrkkiö S, Grénman R, Kurki T, Lindholm P, et al. Experience in qualitative and quantitative FDG PET in follow-up of patients with suspected recurrence from head and neck cancer. Eur J Cancer. 2000;36:858–67.CrossRef
26.
Zurück zum Zitat Vainshtein JM, Spector ME, Stenmark MH, Bradford CR, Wolf GT, Worden FP, et al. Reliability of post-chemoradiotherapy F-18-FDG PET/CT for prediction of locoregional failure in human papillomavirus-associated oropharyngeal cancer. Oral Oncol. 2014;50:234–9.CrossRef Vainshtein JM, Spector ME, Stenmark MH, Bradford CR, Wolf GT, Worden FP, et al. Reliability of post-chemoradiotherapy F-18-FDG PET/CT for prediction of locoregional failure in human papillomavirus-associated oropharyngeal cancer. Oral Oncol. 2014;50:234–9.CrossRef
27.
Zurück zum Zitat Ly J, Minarik D, Edenbrandt L, Wollmer P, Trägårdh E. The use of a proposed updated EARL harmonization of 18F-FDG PET-CT in patients with lymphoma yields significant differences in Deauville score compared with current EARL recommendations. EJNMMI Res. 2019. Ly J, Minarik D, Edenbrandt L, Wollmer P, Trägårdh E. The use of a proposed updated EARL harmonization of 18F-FDG PET-CT in patients with lymphoma yields significant differences in Deauville score compared with current EARL recommendations. EJNMMI Res. 2019.
28.
Zurück zum Zitat Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl med. 1994;35:1308–12 Available from: http://www.ncbi.nlm.nih.gov/pubmed/8046485 . Accessed 9 February 2020. Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl med. 1994;35:1308–12 Available from: http://www.ncbi.nlm.nih.gov/pubmed/8046485 . Accessed 9 February 2020.
Metadaten
Titel
Quantification of 18F-fluorodeoxyglucose uptake to detect residual nodal disease in locally advanced head and neck squamous cell carcinoma after chemoradiotherapy: results from the ECLYPS study
verfasst von
Nils Helsen
Tim Van den Wyngaert
Laurens Carp
Remco De Bree
Olivier M. VanderVeken
Frank De Geeter
Alex Maes
Jean-Philippe Cambier
Karoline Spaepen
Michel Martens
Sara Hakim
Laurence Beels
Otto S. Hoekstra
Danielle Van den Weyngaert
Sigrid Stroobants
Carl Van Laer
Pol Specenier
Annelies Maes
Philip Debruyne
Isabel Hutsebaut
Joost Van Dinter
Filip Homans
Laurence Goethals
Oliver Lenssen
Kristof Deben
ECLYPS Consortium
Publikationsdatum
10.02.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 5/2020
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-020-04710-4

Weitere Artikel der Ausgabe 5/2020

European Journal of Nuclear Medicine and Molecular Imaging 5/2020 Zur Ausgabe