Prospective Imaging Assessment of Mortality Risk After Head-and-Neck Radiotherapy

Journal Article · Mon Nov 01 00:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.08.063· OSTI ID:21437993

Moeller, Benjamin J; Rana, Vishal; Cannon, Blake A ^[1]; Williams, Michelle D ^[2]; Sturgis, Erich M ^[3]; Ginsberg, Lawrence E ^[4]; Macapinlac, Homer A ^[5]; Lee, J Jack ^[6]; Ang, K Kian; Chao, K.S. Clifford; Chronowski, Gregory M; Frank, Steven J; Morrison, William H; Rosenthal, David I ^[1]; Weber, Randal S ^[3]; Garden, Adam S ^[1]; Lippman, Scott M ^[7]

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1. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
2. Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
3. Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
4. Department of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
5. Department of Nuclear Medicine, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
6. Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
7. Department of Thoracic/Head and Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

Purpose: The optimal roles for imaging-based biomarkers in the management of head-and-neck cancer remain undefined. Unresolved questions include whether functional or anatomic imaging might improve mortality risk assessment for this disease. We addressed these issues in a prospective institutional trial. Methods and Materials: Ninety-eight patients with locally advanced pharyngolaryngeal squamous cell cancer were enrolled. Each underwent pre- and post-chemoradiotherapy contrast-enhanced computed tomography (CT) and {sup 18}F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT imaging. Imaging parameters were correlated with survival outcomes. Results: Low post-radiation primary tumor FDG avidity correlated with improved survival on multivariate analysis; so too did complete primary tumor response by CT alone. Although both imaging modalities lacked sensitivity, each had high specificity and negative predictive value for disease-specific mortality risk assessment. Kaplan-Meier estimates confirmed that both CT and FDG-PET/CT stratify patients into distinct high- and low-probability survivorship groups on the basis of primary tumor response to radiotherapy. Subset analyses demonstrated that the prognostic value for each imaging modality was primarily derived from patients at high risk for local treatment failure (human papillomavirus [HPV]-negative disease, nonoropharyngeal primary disease, or tobacco use). Conclusions: CT alone and FDG-PET/CT are potentially useful tools in head-and-neck cancer-specific mortality risk assessment after radiotherapy, particularly for selective use in cases of high-risk HPV-unrelated disease. Focus should be placed on corroboration and refinement of patient selection for imaging-based biomarkers in future studies.

• OSTI ID: 21437993
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 78, Issue 3; Other Information: DOI: 10.1016/j.ijrobp.2009.08.063; PII: S0360-3016(09)03033-8; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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