What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis

Pierluigi Bonomo; A Merlotti; E Olmetto; A Bianchi; I Desideri; A Bacigalupo; P Franco; C Franzese; E Orlandi; L Livi; S Caini

doi:10.1007/s00259-018-4065-5

What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis

Eur J Nucl Med Mol Imaging. 2018 Nov;45(12):2122-2138. doi: 10.1007/s00259-018-4065-5. Epub 2018 Jun 9.

Authors

Pierluigi Bonomo¹, A Merlotti², E Olmetto³, A Bianchi⁴, I Desideri³, A Bacigalupo⁵, P Franco⁶, C Franzese⁷, E Orlandi⁸, L Livi³, S Caini⁹

Affiliations

¹ Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy. bonomopierlu@gmail.com.
² Radiation Oncology, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy.
³ Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, largo Brambilla 3, 50134, Florence, Italy.
⁴ Nuclear Medicine Department, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy.
⁵ Radiation Oncology Department, Ospedale Policlinico San Martino, Genoa, Italy.
⁶ Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
⁷ Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
⁸ Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁹ Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy.

Abstract

Purpose: Evidence is conflicting on the prognostic value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of our study was to determine the impact of semiquantitative and qualitative metabolic parameters on the outcome in patients managed with standard treatment for locally advanced disease.

Methods: A systematic review of the literature was conducted. A meta-analysis was performed of studies providing estimates of relative risk (RR) for the association between semiquantitative metabolic parameters and efficacy outcome measures.

Results: The analysis included 25 studies, for a total of 2,223 subjects. The most frequent primary tumour site was the oropharynx (1,150/2,223 patients, 51.7%). According to the available data, the majority of patients had stage III/IV disease (1,709/1,799, 94.9%; no information available in four studies) and were treated with standard concurrent chemoradiotherapy (1,562/2,009 patients, 77.7%; only one study without available information). A total of 11, 8 and 4 independent studies provided RR estimates for the association between baseline FDG PET metrics and overall survival (OS), progression-free survival (PFS) and locoregional control (LRC), respectively. High pretreatment metabolic tumour volume (MTV) was significantly associated with a worse OS (summary RR 1.86, 95% CI 1.08-3.21), PFS (summary RR 1.81, 95% CI 1.14-2.89) and LRC (summary RR 3.49, 95% CI 1.65-7.35). Given the large heterogeneity (I² > 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUV_max and any of the outcome measures.

Conclusion: FDG PET has prognostic relevance in the context of locally advanced head and neck squamous cell carcinoma. Pretreatment MTV is the only metabolic variable with a significant impact on patient outcome. Because of the heterogeneity and the lack of standardized methodology, no definitive conclusions on optimal cut-off values can be drawn.

Keywords: 18F-Fluorodeoxyglucose (FDG) positron emission tomography; Head and neck cancer; Metabolic tumour volume; Radiotherapy.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Chemoradiotherapy*
Fluorodeoxyglucose F18*
Humans
Positron-Emission Tomography / methods*
Prognosis
Squamous Cell Carcinoma of Head and Neck / diagnostic imaging*
Squamous Cell Carcinoma of Head and Neck / pathology
Squamous Cell Carcinoma of Head and Neck / therapy*

Substances

Fluorodeoxyglucose F18