David L Schwartz1, Jonathan Harris2, Min Yao3, David I Rosenthal4, Adam Opanowski5, Anthony Levering5, K Kian Ang4, Andy M Trotti6, Adam S Garden4, Christopher U Jones7, Paul Harari8, Robert Foote9, John Holland10, Qiang Zhang2, Quynh-Thu Le11. 1. Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, Texas. Electronic address: david.schwartz@utsw.edu. 2. Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania. 3. Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio. 4. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. 5. American College of Radiology Imaging Network, Philadelphia, Pennsylvania. 6. Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida. 7. Sutter Medical Group, Sacramento, California. 8. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 9. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 10. Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon. 11. Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California.
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: 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.
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 tumorMTV 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 tumorMTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumorMTV as a prognostic imaging biomarker for patient stratification in future trials.
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