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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

[ Vol. 10 , Issue. 2 ]

Author(s):

Paola Mapelli, Sara Broggi, Elena Incerti, Pierpaolo Alongi, Margarita Kirienko, Claudio Fiorino, Italo Dell`Oca, Federico Fallanca, Emilia Giovanna Vanoli, Nadia Gisella Di Muzio, Luigi Gianolli and Maria Picchio*   Pages 102 - 110 ( 9 )

Abstract:


Objective: 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 (SUVmax and SUVmean, respectively), 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 was investigated.

Results: The median follow-up was 37 months (range: 3-125). The 3-year OS, CSS, DFS, LRFST, LRFS-N and DMFS were 86%, 88%, 76%, 83%, 88% and 91%, respectively. BTVT+ N>30.9cc and BTV-T>22.4cc were correlated with CSS (p=0.02) and OS (p=0.006) respectively; TLG-T-60>34.6cc was correlated with CSS (p=0.04) and OS (p=0.01). MTV-T-60>4.4cc could predict a higher risk of relapse/death (CSS: p=0.033; hazard ratio (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).

Conclusion: PET parameters predicted survival outcomes and may be considered in the future in the implementation of more personalized treatment schedules in patients affected by OSCC undergoing radiotherapy. FDG-PET/CT dose escalated HTT-SIB allowed very promising 3-year disease control rates in OSCC patients.

Keywords:

FDG-PET/CT, SUV, MTV, TLG, oropharyngeal cancer, radiotherapy, survival outcomes.

Affiliation:

Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Medical Physics Department, IRCCS San Raffaele Scientific Institute, Milan, Radiation Oncology Department, IRCCS Scientific Institute San Raffaele, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Radiation Oncology Department, IRCCS Scientific Institute San Raffaele, Mila, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan

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