Head and neck squamous cell cancer (stages III and IV) induction chemotherapy assessment: value of FDG volumetric imaging parameters

J Med Imaging Radiat Oncol. 2014 Feb;58(1):18-24. doi: 10.1111/1754-9485.12081. Epub 2013 Jun 3.


Introduction: To evaluate whether the change in the metabolic tumour volume (MTV) or total lesion glycolysis (TLG) of the primary tumour, before and after induction chemotherapy, predicts outcome for patients with advanced head and neck squamous cell cancer (SCC).

Methods: Twenty-eight patients with advanced (American Joint Committee on Cancer stage III and IV) head and neck SCC who underwent positron emission tomography (PET)/CT were included in this retrospective study. Primary tumour MTV and TLG were measured using gradient and fixed percentage threshold segmentations. Outcome endpoint was disease progression or mortality. Pearson correlation, Bland-Altman and receiver operator characteristic analysis were performed.

Results: The Pearson's correlation coefficients between percentage changes (pre- and post-induction chemotherapy) from gradient MTV (MTVG) and the 38% SUVmax threshold MTV (MTV38) was 0.96 and between MTVG and the 50% threshold MTV (MTV50) was 0.95 (P < 0.0001). The corresponding Pearson r between TLGG and TLG38 was 0.94 and between TLGG and TLG50 was 0.96 (P < 0.0001). The least bias was 1.89% (standard deviation = 25.30%) between the percentage changes of MTVG and MTV50. The areas under the curve for predicting progression or mortality were 0.76 (P = 0.03) for MTVG and 0.82 for TLGG (P = 0.009). Optimum cut points of a 42% reduction in MTVG and a 55% reduction in the TLGG predict event-free survival with a sensitivity of 62.5% and a specificity of 90% and a hazards ratio of 6.25.

Conclusion: A reduction in primary tumour MTV of at least 42% or in TLG of at least 55% after induction chemotherapy may predict event-free survival in patients with advanced head and neck SCC.

Keywords: PET/CT; head and neck.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / drug therapy*
  • Carcinoma, Squamous Cell / metabolism
  • Computer Simulation
  • Disease-Free Survival
  • Female
  • Fluorodeoxyglucose F18* / pharmacokinetics
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / drug therapy*
  • Head and Neck Neoplasms / metabolism
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Imaging, Three-Dimensional / methods*
  • Induction Chemotherapy / methods*
  • Male
  • Middle Aged
  • Models, Biological
  • Neoplasm Staging
  • Prognosis
  • Radionuclide Imaging
  • Radiopharmaceuticals / pharmacokinetics
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Squamous Cell Carcinoma of Head and Neck
  • Treatment Outcome
  • Tumor Burden


  • Antineoplastic Agents
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18