18F-FLT PET During Radiotherapy or Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma Is an Early Predictor of Outcome

Journal of Nuclear Medicine

Wim J.G. Oyen¹  Bianca A.W. Hoeben¹  Carla M.L. van Herpen¹  Johannes H.A.M. Kaanders¹  Paul N. Span¹  Esther G.C. Troost¹  Johan Bussink¹ 

关键词: ¹⁸F-fluorothymidine PET;    head and neck cancer;    early response monitoring;   

DOI  :  10.2967/jnumed.112.105999

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

This prospective study used sequential PET with the proliferation tracer 3′-deoxy-3′-18F-fluorothymidine (18F-FLT) to monitor the early response to treatment of head and neck cancer and evaluated the association between PET parameters and clinical outcome. Methods: Forty-eight patients with head and neck cancer underwent 18F-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. Results: 18F-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 18F-FLT uptake levels during treatment, GTVSBR and GTV50% were unsuccessful in segmenting primary tumor volume. Conclusion: In head and neck cancer, a change in 18F-FLT uptake early during radiotherapy or chemoradiotherapy is a strong indicator for long-term outcome. 18F-FLT PET may thus aid in personalized patient management by steering treatment modifications during an early phase of therapy.

【 授权许可】

Unknown