TY - JOUR
T1 - F-18-FLT PET During Radiotherapy or Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma Is an Early Predictor of Outcome
AU - Hoeben, Bianca A. W.
AU - Troost, Esther G. C.
AU - Span, Paul N.
AU - van Herpen, Carla M. L.
AU - Bussink, Johan
AU - Oyen, Wim J. G.
AU - Kaanders, Johannes H. A. M.
PY - 2013/4/1
Y1 - 2013/4/1
N2 - This prospective study used sequential PET with the proliferation tracer 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) to monitor the early response to treatment of head and neck cancer and evaluated the association between PET parameters and clinical outcome.Forty-eight patients with head and neck cancer underwent (18)F-FLT PET/CT before and during the second and fourth weeks of radiotherapy or chemoradiotherapy. Mean maximum standardized uptake values for the hottest voxel in the tumor and its 8 surrounding voxels in 1 transversal slice (SUVmax(9)) of the PET scans were calculated, as well as PET-segmented gross tumor volumes using visual delineation (GTVVIS) and operator-independent methods based on signal-to-background ratio (GTVSBR) and 50% isocontour of the maximum signal intensity (GTV50%). PET parameters were evaluated for correlations with outcome.(18)F-FLT uptake decreased significantly between consecutive scans. An SUVmax(9) decline ? 45% and a GTVVIS decrease ? median during the first 2 treatment weeks were associated with better 3-y disease-free survival (88% vs. 63%, P = 0.035, and 91% vs. 65%, P = 0.037, respectively). A GTVVIS decrease ? median in the fourth treatment week was also associated with better 3-y locoregional control (100% vs. 68%, P = 0.021). These correlations were most prominent in the subset of patients treated with chemoradiotherapy. Because of low (18)F-FLT uptake levels during treatment, GTVSBR and GTV50% were unsuccessful in segmenting primary tumor volume.In head and neck cancer, a change in (18)F-FLT uptake early during radiotherapy or chemoradiotherapy is a strong indicator for long-term outcome. (18)F-FLT PET may thus aid in personalized patient management by steering treatment modifications during an early phase of therapy.
AB - This prospective study used sequential PET with the proliferation tracer 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) to monitor the early response to treatment of head and neck cancer and evaluated the association between PET parameters and clinical outcome.Forty-eight patients with head and neck cancer underwent (18)F-FLT PET/CT before and during the second and fourth weeks of radiotherapy or chemoradiotherapy. Mean maximum standardized uptake values for the hottest voxel in the tumor and its 8 surrounding voxels in 1 transversal slice (SUVmax(9)) of the PET scans were calculated, as well as PET-segmented gross tumor volumes using visual delineation (GTVVIS) and operator-independent methods based on signal-to-background ratio (GTVSBR) and 50% isocontour of the maximum signal intensity (GTV50%). PET parameters were evaluated for correlations with outcome.(18)F-FLT uptake decreased significantly between consecutive scans. An SUVmax(9) decline ? 45% and a GTVVIS decrease ? median during the first 2 treatment weeks were associated with better 3-y disease-free survival (88% vs. 63%, P = 0.035, and 91% vs. 65%, P = 0.037, respectively). A GTVVIS decrease ? median in the fourth treatment week was also associated with better 3-y locoregional control (100% vs. 68%, P = 0.021). These correlations were most prominent in the subset of patients treated with chemoradiotherapy. Because of low (18)F-FLT uptake levels during treatment, GTVSBR and GTV50% were unsuccessful in segmenting primary tumor volume.In head and neck cancer, a change in (18)F-FLT uptake early during radiotherapy or chemoradiotherapy is a strong indicator for long-term outcome. (18)F-FLT PET may thus aid in personalized patient management by steering treatment modifications during an early phase of therapy.
KW - F-18-fluorothymidine PET
KW - head and neck cancer
KW - early response monitoring
U2 - 10.2967/jnumed.112.105999
DO - 10.2967/jnumed.112.105999
M3 - Article
C2 - 23345303
SN - 0161-5505
VL - 54
SP - 532
EP - 540
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 4
ER -