Mid-treatment Fluorodeoxyglucose Positron Emission Tomography in Human Papillomavirus-related Oropharyngeal Squamous Cell Carcinoma Treated with Primary Radiotherapy: Nodal Metabolic Response Rate can Predict Treatment Outcomes,Clinical Oncology

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Mid-treatment Fluorodeoxyglucose Positron Emission Tomography in Human Papillomavirus-related Oropharyngeal Squamous Cell Carcinoma Treated with Primary Radiotherapy: Nodal Metabolic Response Rate can Predict Treatment Outcomes
Clinical Oncology ( IF 3.2 ) Pub Date : 2021-08-07 , DOI: 10.1016/j.clon.2021.07.011
P Lin ₁ , M Min ₂ , K Lai ₃ , M Lee ₄ , L Holloway ₅ , W Xuan ₆ , V Bray ₇ , A Fowler ₇ , C S Lee ₈ , J Yong ₉

Affiliation

Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia.
Department of Radiation Oncology, Sunshine Coast University Hospital, Queensland, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Queensland, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.
Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia.
South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.
South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.
South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.
Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.
South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia; Central Clinical School, University of Sydney, New South Wales, Australia.
Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia.

Aims

To evaluate whether biomarkers derived from fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) performed prior to (prePET) and during the third week (interim PET; iPET) of radiotherapy can predict treatment outcomes in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPC).

Materials and methods

This retrospective analysis included 46 patients with newly diagnosed OPC treated with definitive (chemo)radiation and all patients had confirmed positive HPV status (HPV+OPC) based on p16 immunohistochemistry. The maximum standardised uptake value (SUV_max), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary, index node (node with the highest TLG) and total lymph nodes and their median percentage (≥50%) reductions in iPET were analysed, and correlated with 5-year Kaplan–Meier and multivariable analyses (smoking, T4, N2b-3 and AJCC stage IV), including local failure-free survival, regional failure-free survival, locoregional failure-free survival (LRFFS), distant metastatic failure-free survival (DMFFS), disease-free survival (DFS) and overall survival.

Results

There was no association of outcomes with prePET parameters observed on multivariate analysis. A complete metabolic response of primary tumour was seen in 13 patients; the negative predictive value for local failure was 100%. More than a 50% reduction in total nodal MTV provided the best predictor of outcomes, including LRFFS (88% versus 47.1%, P = 0.006, hazard ratio = 0.153) and DFS (78.2% versus 41.2%, P = 0.01, hazard ratio = 0.234). More than a 50% reduction in index node TLG was inversely related to DMFFS: a better nodal response was associated with a higher incidence of distant metastatic failure (66.7% versus 100%, P = 0.009, hazard ratio = 3.0).

Conclusion

The reduction (≥50%) of volumetric nodal metabolic burden can potentially identify a subgroup of HPV+OPC patients at low risk of locoregional failure but inversely at higher risk of distant metastatic failure and may have a role in individualised adaptive radiotherapy and systemic therapy.

中文翻译：

人乳头瘤病毒相关口咽鳞状细胞癌的中期治疗氟脱氧葡萄糖正电子发射断层扫描术：淋巴结代谢反应率可以预测治疗结果

宗旨

评估在放疗前（prePET）和第三周（临时 PET；iPET）进行的氟脱氧葡萄糖正电子发射断层扫描计算机断层扫描 (FDG PET-CT) 衍生的生物标志物是否可以预测人乳头瘤病毒 (HPV) 阳性的治疗结果口咽鳞状细胞癌 (OPC)。

材料和方法

该回顾性分析包括 46 名接受根治性（化学）放射治疗的新诊断 OPC 患者，所有患者均已根据 p16 免疫组织化学确认阳性 HPV 状态（HPV+OPC）。原发性、指标淋巴结（具有最高 TLG 的淋巴结）和总淋巴结的最大标准化摄取值 (SUV _max )、代谢肿瘤体积 (MTV) 和总病变糖酵解 (TLG) 及其中位数百分比 (≥50%)对 iPET 进行了分析，并与 5 年 Kaplan-Meier 和多变量分析（吸烟、T4、N2b-3 和 AJCC IV 期）相关联，包括局部无失败生存率、区域无失败生存率、局部无失败生存率 (LRFFS) )、远处转移无失败生存期 (DMFFS)、无病生存期 (DFS) 和总生存期。

结果

在多变量分析中观察到的结果与 prePET 参数没有关联。原发肿瘤完全代谢反应13例；局部失败的阴性预测值为 100%。总淋巴结 MTV 减少 50% 以上提供了最好的结果预测指标，包括 LRFFS（88% 对 47.1%，P = 0.006，风险比 = 0.153）和 DFS（78.2% 对 41.2%，P = 0.01，风险比） = 0.234）。指标淋巴结 TLG 减少超过 50% 与 DMFFS 呈负相关：更好的淋巴结反应与更高的远处转移失败发生率相关（66.7% 对 100%，P = 0.009，风险比 = 3.0）。