Differential Prognostic Value of Metabolic Heterogeneity of Primary Tumor and Metastatic Lymph Nodes in Patients with Pharyngeal Cancer

Anticancer Res. 2017 Oct;37(10):5899-5905. doi: 10.21873/anticanres.12036.


Background/aim: We aimed to explore the prognostic value of metabolic heterogeneity of 18F-FDG uptake in chemoradiotherapy-treated pharyngeal cancer patients.

Patients and methods: This study included 52 consecutive patients with pharyngeal cancer who underwent 18F-FDG PET/CT before definitive chemoradiotherapy. The heterogeneity factor (HF) was defined as the derivative (dV/dT) of a volume-threshold function for primary tumors and metastatic lymph nodes. The relationships between clinical parameters and HFs of primary tumors (pHF) and metastatic lymph nodes (nHF) were analyzed.

Results: The pHF (range=∓1.367 - -0.027; median=-0.152) was significantly correlated with the maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis. Induction chemotherapy response was not correlated with HF, whereas response to radiotherapy was significantly better in patients with high pHF (low heterogeneity). Consistently, the 2-year locoregional recurrence-free survival was significantly better in patients with high pHF (82.9% for pHF>-0.152 vs. 30.5% for pHF<-0.152, log-rank p=0.009). The nHF (range=-1.067 - -0.039; median=-0.160) was not correlated with response to radiotherapy and locoregional recurrences.

Conclusion: pHF, but not nHF, was a significant predictor of response to radiotherapy and locoregional recurrence in pharyngeal cancer. Thus, HF use can prevent unnecessary treatment and surgical delays.

Keywords: Metabolic heterogeneity; PET; chemoradiotherapy; pharyngeal cancer.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / metabolism
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / therapy
  • Chemoradiotherapy
  • Disease-Free Survival
  • Female
  • Fluorodeoxyglucose F18 / administration & dosage*
  • Fluorodeoxyglucose F18 / metabolism
  • Glycolysis
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / metabolism
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy
  • Humans
  • Kaplan-Meier Estimate
  • Lymph Nodes / diagnostic imaging*
  • Lymph Nodes / metabolism
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Pharyngeal Neoplasms / diagnostic imaging*
  • Pharyngeal Neoplasms / metabolism
  • Pharyngeal Neoplasms / pathology
  • Pharyngeal Neoplasms / therapy
  • Positron Emission Tomography Computed Tomography*
  • Predictive Value of Tests
  • Radiopharmaceuticals / administration & dosage*
  • Radiopharmaceuticals / metabolism
  • Squamous Cell Carcinoma of Head and Neck
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18