Jeffrey M Vainshtein1, Matthew E Spector2, Matthew H Stenmark3, Carol R Bradford2, Gregory T Wolf2, Francis P Worden4, Douglas B Chepeha2, Jonathan B McHugh5, Thomas Carey2, Ka Kit Wong6, Avraham Eisbruch3. 1. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States. Electronic address: jvainsh@med.umich.edu. 2. Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States. 3. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States. 4. Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States. 5. Department of Pathology, University of Michigan, Ann Arbor, MI, United States. 6. Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, United States.
Abstract
OBJECTIVES: Although widely adopted, the accuracy of post-chemoradiotherapy (CRT) 18F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) for predicting locoregional failure (LRF) in human papillomavirus-related (HPV+) oropharyngeal cancer (OPC) remains poorly characterized. We assessed the predictive value of 3-month PET/CT response for LRF in this population. MATERIALS AND METHODS: 101 consecutive patients with stage III-IV HPV+ OPC who underwent definitive CRT with pre-treatment and 3-month post-CRT PET/CT at our institution from 3/2005-3/2011 were included. 3-month PET/CT response was re-classified as complete-response (CR), near-CR, or incomplete-response (<CR) for each the primary site and neck. Accuracy of 3-month PET/CT for predicting local failure (LF) and regional failure (RF) was analyzed. RESULTS: Among 98 patients with an evaluable primary tumor, LF occurred in 2/67 patients with CR, 0/20 with near-CR, and 1/11 with <CR on 3-month PET/CT. Of 98 node-positive patients, RF occurred in 6/80 with CR, 2/9 with near-CR, and 0/7 with <CR in the neck at 3 months. Sensitivity and positive predictive value (PPV) of 3-month PET/CT response for LF and RF were low (0-33%), despite a high negative predictive value (NPV) (91-98%). SUVmax thresholds or % change did not improve the accuracy of 3-month PET/CT. Use of additional PET/CT surveillance after 3 months in 67 patients accurately detected both LF (96%) and RF (97%). CONCLUSIONS: In the largest study to-date of PET/CT response assessment in HPV+ OPC, 3-month PET/CT response demonstrated high NPV for LRF, though with disappointing sensitivity and PPV. Subsequent PET/CT surveillance showed potential utility for early detection of LRFs.
OBJECTIVES: Although widely adopted, the accuracy of post-chemoradiotherapy (CRT) 18F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) for predicting locoregional failure (LRF) in human papillomavirus-related (HPV+) oropharyngeal cancer (OPC) remains poorly characterized. We assessed the predictive value of 3-month PET/CT response for LRF in this population. MATERIALS AND METHODS: 101 consecutive patients with stage III-IV HPV+ OPC who underwent definitive CRT with pre-treatment and 3-month post-CRT PET/CT at our institution from 3/2005-3/2011 were included. 3-month PET/CT response was re-classified as complete-response (CR), near-CR, or incomplete-response (<CR) for each the primary site and neck. Accuracy of 3-month PET/CT for predicting local failure (LF) and regional failure (RF) was analyzed. RESULTS: Among 98 patients with an evaluable primary tumor, LF occurred in 2/67 patients with CR, 0/20 with near-CR, and 1/11 with <CR on 3-month PET/CT. Of 98 node-positive patients, RF occurred in 6/80 with CR, 2/9 with near-CR, and 0/7 with <CR in the neck at 3 months. Sensitivity and positive predictive value (PPV) of 3-month PET/CT response for LF and RF were low (0-33%), despite a high negative predictive value (NPV) (91-98%). SUVmax thresholds or % change did not improve the accuracy of 3-month PET/CT. Use of additional PET/CT surveillance after 3 months in 67 patients accurately detected both LF (96%) and RF (97%). CONCLUSIONS: In the largest study to-date of PET/CT response assessment in HPV+ OPC, 3-month PET/CT response demonstrated high NPV for LRF, though with disappointing sensitivity and PPV. Subsequent PET/CT surveillance showed potential utility for early detection of LRFs.
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