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Abstract

PURPOSE:
Induction chemotherapy (ICT) with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiotherapy(CCRT) has the advantages of organ preservation and systemic control in head and neck cancer (HNC). Early prediction of CCRT efficacymay help identify patients who will benefit more from surgery than from CCRT. We investigated the role of interim 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (FDG PET-CT) after ICT to predict the efficacy of CCRT and clinical outcomes.

METHODS:
Tumor responses were retrospectively reviewed after CCRT based on the Response Evaluation Criteria in Solid Tumors. FDGPET-CT imaging was performed before and after three cycles of TPF. We examined the associations between the metabolic response (percentage decrease in the maximum standardized uptake value [SUVmax] and total metabolic tumor volume [MTV]) after ICT and complete response (CR) to CCRT, progression-free survival (PFS), and overall survival (OS).

RESULTS:
We studied 43 HNC patients with a median follow-up of 32.7 months. Lymph node (LN) SUVmax and total MTV decreases from baseline after ICT were greater in patients with a CR to CCRT than in non-CR patients (LN SUVmax, 88.8% vs. 62.5%, respectively; total MTV, 99.7% vs. 89.9%, respectively). Decreases in total MTV ≥ 78% and LN SUVmax ≥73% after ICT predicted CR to CCRT and longer OS and PFS.

CONCLUSIONS:
Using interim FDG PET-CT to measure SUVmax and total MTV after three cycles of ICT may be a useful technique for identifying HNC patients who will benefit from CCRT and predicting survival outcomes.

Author information

Kim KR1, Shim HJ1, Hwang JE1, Cho SH1, Chung IJ1, Park KS2, Kang SR2, Kwon SY2, Chung WK3, Bae WK4,5.

1 Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea.
2 Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
3 Department of Radiation-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea.
4 Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea. drwookyun@jnu.ac.kr.
5 Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea. drwookyun@jnu.ac.kr.

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