FDG-PET/CT predicts outcome in oropharingeal carcinoma patients undergoing intensity modulated radiation therapy with dose escalation to FDG-avid tumour volumes.

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FDG-PET/CT predicts outcome in oropharingeal carcinoma patients undergoing intensity modulated radiation therapy with dose escalation to FDG-avid tumour volumes.

Curr Radiopharm. 2017 Apr 13;:

Authors: Mapelli P, Broggi S, Incerti E, Alongi P, Kirienko M, Fiorino C, Dell Oca I, Fallanca F, Vanoli EG, Di Muzio NG, Gianolli L, Picchio M

Abstract
PURPOSE: To evaluate the predictive value of FDG-PET/CT parameters on outcome of oropharyngeal squamocellular cancer (OSCC) patients undergoing helical tomotherapy (HTT), with dose escalation to FDG-PET/CT positive tumour volumes using the simultaneous integrated boost (SIB) technique.
MATERIALS AND METHODS: We analysed 41 patients studied by FDG-PET/CT and treated with radical intent between 2005 and 2014 for OSCC. HTT-SIB was delivered in 30 fractions concomitantly: 69 Gy, as SIB, to the PET-positive volume (biological target volume - BTV-PET), both to the primary tumour (T) and lymph nodes (N), 66 Gy to the T and positive N, 54 Gy to the laterocervical nodes at risk. Selected PET parameters were recovered: maximum and mean standardized uptake values (SUV), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) obtained with different thresholds (40-50-60% of the SUVmax) for T and N. The correlation between these parameters and the 3-year overall (OS), cancer specific (CSS), disease free (DFS), local relapse free for T and N (LRFS-T and LRFS-N) and distant metastasis free (DMFS) survivals were investigated.
RESULTS: The median follow-up was 37 months (range: 3-125). The 3-years OS, CSS, DFS, LRFS-T, LRFS-N and DMFS were 86%, 88%, 76%, 83%, 88% and 91%, respectively. BTV-T+N>30.9 cc and BTV-T>22.4 cc were correlated with CSS (p=0.02) and OS (p=0.006) respectively; TLG-T-60>34.6 cc was correlated with CSS (p=0.04) and OS (p=0.01). MTV-T-60>4.4 could predict a higher risk of relapse/death (CSS: p=0.033; HR=10.92; OS: p=0.01; HR=16.4; LRFS-T: p=0.02; HR=13.90; LRFS-T+N: p=0.03; HR=6.50).
CONCLUSIONS: PET parameters predicted survival outcomes and may be considered in the future in the implementation of more personalized treatment schedules in patients affected by oropharyngeal squamocellular cancer undergoing radiotherapy. FDG-PET/CT dose escalated HTT-SIB allowed very promising 3-years disease control rates in OSCC patients.

PMID: 28412923 [PubMed - as supplied by publisher]

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