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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2019 Sep 05

DOI: 10.23736/S1824-4785.19.03179-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Evaluation of quantitative imaging parameters in head and neck squamous cell carcinoma

Tejpal GUPTA 1 , Abhishek CHATTERJEE 1, Venkatesh RANGARAJAN 2, Nilendu PURANDARE 2, Supreeta ARYA 3, Vedang MURTHY 1, Ashwini BUDRUKKAR 1, Sarbani GHOSH-LASKAR 1, Jai Prakash AGARWAL 1

1 Department of Radiation Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, India; 2 Nuclear Medicine & Molecular Imaging, Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, India; 3 Radiodiagnosis, Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, India


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BACKGROUND: Functional imaging such as 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT), 18F-fluoro-misonidazole (F-MISO)-PET/CT, and diffusion-weighted magnetic resonance imaging (DW-MRI) can assess complex biological phenomena in tumors reflecting underlying disease biology. The aim of this prospective observational study was to correlate quantitative imaging parameters derived from pre-treatment biological imaging such as FDG-PET/CT, F-MISO-PET/CT, and DW-MRI with each other andì with clinical outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with definitive radio(chemo)therapy.
METHODS: Twenty patients with pharyngo-laryngeal cancers underwent pre-treatment biological imaging. Gross tumor volume (GTV) was delineated on axial planning CT (GTVCT). Quantitative FDG-PET/CT parameters included maximum, mean, minimum standardized uptake values (SUVmax-FDG, SUVmean-FDG, SUVmin-FDG); metabolic tumor volume (MTV); and total lesion glycolysis (TLG). F-MISO-PET/CT parameters included hypoxic tumor volume (HTV); maximum, mean, minimum SUV; and fractional hypoxic volume (FHV). Mean apparent diffusion coefficient (ADCmean) was derived from DW-MRI.
RESULTS: There was moderately strong positive correlation (r=0.616, p=0.005) between GTVCT and MTV. HTV derived from F-MISO-PET/CT at 3-hours (HTV3hrs-F-MISO) showed strong positive correlation with GTVCT (r=0.753, p<0.0001) and MTV (r=0.796, p<0.0001) respectively. ADCmean showed strong positive correlations with SUVmean-5hrs-F-MISO (r=0.713, p=0.021) and SUVmin-5hrs-FMISO (r=0.731, p=0.016) respectively. A moderate negative correlation (r=-0.500, p=0.049) was observed between ADCmean and MTV. At a median follow up of 44 months, the 5-year Kaplan-Meier estimates of loco-regional control, disease-free survival, and overall survival were 53%, 43%, and 40% respectively. Larger volume of primary tumor (GTVCT>22cc and MTV>7.9cc) and increasing hypoxia (HTV3hr-F-MSO>4.9cc) were associated with worse outcomes.
CONCLUSIONS: Functional imaging represents an attractive and non-invasive modality to assess complex biological phenomena in solid tumors. Larger tumor volume and increasing hypoxia emerged as putative prognostic imaging biomarkers in HNSCC.


KEY WORDS: Biomarker; Diffusion; Hypoxia; Imaging; MRI; PET/CT

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