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

Abstract

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:more » 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.« less

Authors:
 [1];  [2];  [3];  [4]; ;  [5];  [4];  [6];  [4];  [7];  [8];  [9];  [10];  [2];  [11]
  1. Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, Texas (United States)
  2. Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States)
  3. Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio (United States)
  4. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  5. American College of Radiology Imaging Network, Philadelphia, Pennsylvania (United States)
  6. Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida (United States)
  7. Sutter Medical Group, Sacramento, California (United States)
  8. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (United States)
  9. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)
  10. Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon (United States)
  11. Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California (United States)
Publication Date:
OSTI Identifier:
22458643
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 91; Journal Issue: 4; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOLOGICAL MARKERS; BIOMEDICAL RADIOGRAPHY; COMBINED THERAPY; FLUORODEOXYGLUCOSE; HEAD; NECK; NEOPLASMS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; RADIOTHERAPY; UPTAKE

Citation Formats

Schwartz, David L., E-mail: david.schwartz@utsw.edu, Harris, Jonathan, Yao, Min, Rosenthal, David I., Opanowski, Adam, Levering, Anthony, Ang, K. Kian, Trotti, Andy M., Garden, Adam S., Jones, Christopher U., Harari, Paul, Foote, Robert, Holland, John, Zhang, Qiang, and Le, Quynh-Thu. Metabolic Tumor Volume as a Prognostic Imaging-Based Biomarker for Head-and-Neck Cancer: Pilot Results From Radiation Therapy Oncology Group Protocol 0522. United States: N. p., 2015. Web. doi:10.1016/J.IJROBP.2014.12.023.
Schwartz, David L., E-mail: david.schwartz@utsw.edu, Harris, Jonathan, Yao, Min, Rosenthal, David I., Opanowski, Adam, Levering, Anthony, Ang, K. Kian, Trotti, Andy M., Garden, Adam S., Jones, Christopher U., Harari, Paul, Foote, Robert, Holland, John, Zhang, Qiang, & Le, Quynh-Thu. Metabolic Tumor Volume as a Prognostic Imaging-Based Biomarker for Head-and-Neck Cancer: Pilot Results From Radiation Therapy Oncology Group Protocol 0522. United States. doi:10.1016/J.IJROBP.2014.12.023.
Schwartz, David L., E-mail: david.schwartz@utsw.edu, Harris, Jonathan, Yao, Min, Rosenthal, David I., Opanowski, Adam, Levering, Anthony, Ang, K. Kian, Trotti, Andy M., Garden, Adam S., Jones, Christopher U., Harari, Paul, Foote, Robert, Holland, John, Zhang, Qiang, and Le, Quynh-Thu. Sun . "Metabolic Tumor Volume as a Prognostic Imaging-Based Biomarker for Head-and-Neck Cancer: Pilot Results From Radiation Therapy Oncology Group Protocol 0522". United States. doi:10.1016/J.IJROBP.2014.12.023.
@article{osti_22458643,
title = {Metabolic Tumor Volume as a Prognostic Imaging-Based Biomarker for Head-and-Neck Cancer: Pilot Results From Radiation Therapy Oncology Group Protocol 0522},
author = {Schwartz, David L., E-mail: david.schwartz@utsw.edu and Harris, Jonathan and Yao, Min and Rosenthal, David I. and Opanowski, Adam and Levering, Anthony and Ang, K. Kian and Trotti, Andy M. and Garden, Adam S. and Jones, Christopher U. and Harari, Paul and Foote, Robert and Holland, John and Zhang, Qiang and Le, Quynh-Thu},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2014.12.023},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 91,
place = {United States},
year = {Sun Mar 15 00:00:00 EDT 2015},
month = {Sun Mar 15 00:00:00 EDT 2015}
}