AUTHOR=Zschaeck Sebastian , Weingärtner Julian , Lombardo Elia , Marschner Sebastian , Hajiyianni Marina , Beck Marcus , Zips Daniel , Li Yimin , Lin Qin , Amthauer Holger , Troost Esther G. C. , van den Hoff Jörg , Budach Volker , Kotzerke Jörg , Ferentinos Konstantinos , Karagiannis Efstratios , Kaul David , Gregoire Vincent , Holzgreve Adrien , Albert Nathalie L. , Nikulin Pavel , Bachmann Michael , Kopka Klaus , Krause Mechthild , Baumann Michael , Kazmierska Joanna , Cegla Paulina , Cholewinski Witold , Strouthos Iosif , Zöphel Klaus , Majchrzak Ewa , Landry Guillaume , Belka Claus , Stromberger Carmen , Hofheinz Frank TITLE=18F-Fluorodeoxyglucose Positron Emission Tomography of Head and Neck Cancer: Location and HPV Specific Parameters for Potential Treatment Individualization JOURNAL=Frontiers in Oncology VOLUME=12 YEAR=2022 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.870319 DOI=10.3389/fonc.2022.870319 ISSN=2234-943X ABSTRACT=Purpose

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is utilized for staging and treatment planning of head and neck squamous cell carcinomas (HNSCC). Some older publications on the prognostic relevance showed inconclusive results, most probably due to small study sizes. This study evaluates the prognostic and potentially predictive value of FDG-PET in a large multi-center analysis.

Methods

Original analysis of individual FDG-PET and patient data from 16 international centers (8 institutional datasets, 8 public repositories) with 1104 patients. All patients received curative intent radiotherapy/chemoradiation (CRT) and pre-treatment FDG-PET imaging. Primary tumors were semi-automatically delineated for calculation of SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Cox regression analyses were performed for event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM).

Results

FDG-PET parameters were associated with patient outcome in the whole cohort regarding clinical endpoints (EFS, OS, LRC, FFDM), in uni- and multivariate Cox regression analyses. Several previously published cut-off values were successfully validated. Subgroup analyses identified tumor- and human papillomavirus (HPV) specific parameters. In HPV positive oropharynx cancer (OPC) SUVmax was well suited to identify patients with excellent LRC for organ preservation. Patients with SUVmax of 14 or less were unlikely to develop loco-regional recurrence after definitive CRT. In contrast FDG PET parameters deliver only limited prognostic information in laryngeal cancer.

Conclusion

FDG-PET parameters bear considerable prognostic value in HNSCC and potential predictive value in subgroups of patients, especially regarding treatment de-intensification and organ-preservation. The potential predictive value needs further validation in appropriate control groups. Further research on advanced imaging approaches including radiomics or artificial intelligence methods should implement the identified cut-off values as benchmark routine imaging parameters.