Metabolic Tumor Volume as a Prognostic Imaging-Based Biomarker for Head-and-Neck Cancer: Pilot Results From Radiation Therapy Oncology Group Protocol 0522

Journal Article · Sun Mar 15 04:00:00 EDT 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2014.12.023· OSTI ID:22458643

Harris, Jonathan ^[1]; Yao, Min ^[2]; Rosenthal, David I. ^[3]; Opanowski, Adam; Levering, Anthony ^[4]; Ang, K. Kian ^[3]; Trotti, Andy M. ^[5]; Garden, Adam S. ^[3]; Jones, Christopher U. ^[6]; Harari, Paul ^[7]; Foote, Robert ^[8]; Holland, John ^[9]; Zhang, Qiang ^[1]; Le, Quynh-Thu ^[10]

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1. Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States)
2. Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio (United States)
3. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
4. American College of Radiology Imaging Network, Philadelphia, Pennsylvania (United States)
5. Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida (United States)
6. Sutter Medical Group, Sacramento, California (United States)
7. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (United States)
8. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)
9. Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon (United States)
10. Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California (United States)

Purpose: To evaluate candidate fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging biomarkers for head-and-neck chemoradiotherapy outcomes in the cooperative group trial setting. Methods and Materials: Radiation Therapy Oncology Group (RTOG) protocol 0522 patients consenting to a secondary FDG-PET/CT substudy were serially imaged at baseline and 8 weeks after radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1-cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40% of SUVmax as threshold were obtained from primary tumor and involved nodes. Results: Of 940 patients entered onto RTOG 0522, 74 were analyzable for this substudy. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse local-regional control (hazard ratio 4.01, 95% confidence interval 1.28-12.52, P=.02) and progression-free survival (hazard ratio 2.34, 95% confidence interval 1.02-5.37, P=.05). Although MTV and T stage seemed to correlate (mean MTV 6.4, 13.2, and 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for progression-free survival in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited. Conclusion: High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.

• OSTI ID: 22458643
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 91; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BIOLOGICAL MARKERS
BIOMEDICAL RADIOGRAPHY
COMBINED THERAPY
FLUORODEOXYGLUCOSE
HEAD
NECK
NEOPLASMS
PATIENTS
POSITRON COMPUTED TOMOGRAPHY
RADIOTHERAPY
UPTAKE