Rick Wray1, Sara Sheikhbahaei1, Charles Marcus1, Elcin Zan1, Regan Ferraro1, Arman Rahmim1, Rathan M Subramaniam2,3,4,5. 1. 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD. 2. 2 Department of Radiology, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 3. 3 Advanced Imaging Research Center, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 4. 4 Department of Clinical Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 5. 5 Harold C. Simmons Comprehensive Cancer Center, Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390.
Abstract
OBJECTIVE: This study investigates the prognostic value of (18)F-FDG PET/CT qualitative therapy assessment (Hopkins criteria) in patients with head and neck squamous cell carcinomas (HNSCCs) with residual neck nodes after definitive chemoradiation therapy and compares the Hopkins criteria with anatomic nodal size and morphologic features for prediction of survival outcomes. MATERIALS AND METHODS: A total of 72 patients with HNSCC, with negative primary tumor and positive residual neck nodes (CT criteria > 1 cm short-axis diameter) after the completion of definitive chemoradiation therapy, were included. PET/CT was performed 6-24 weeks after completion of treatment. FDG uptake in residual nodes on PET/CT was interpreted using a structured qualitative 5-point scale (Hopkins criteria). The 5-point scale was dichotomized to negative (scores 1, 2, and 3) or positive (scores 4 and 5) results. Cystic or necrotic nodes were defined as those with central low attenuation with a relatively hyperdense capsule. Kaplan-Meier curve and Cox regression analysis were performed. RESULTS: On the basis of the Hopkins criteria, 10 (13.9%) patients had positive findings and 62 (86.1%) had negative findings for residual nodal disease. According to CT interpretation, 25 patients (34.7%) had residual cervical lymph nodes greater than or equal to 1.5 cm in diameter, and 41 (56.9%) patients had cystic or necrotic nodes. Patients were followed for a median of 27 months after posttherapy PET/CT. There was a statistically significant difference in overall survival (OS) (hazard ratio, 7.06; p < 0.001) and progression-free survival (PFS) (hazard ratio, 6.18; p < 0.001) between patients with negative versus positive residual FDG nodal uptake. There was no statistically significant difference in OS and PFS in patients categorized on the basis of nodal size or morphologic features. CONCLUSION: PET-based structured qualitative therapy assessment (Hopkins criteria) can predict survival outcomes of patients with HNSCC with residual neck nodes after definitive chemoradiotherapy.
OBJECTIVE: This study investigates the prognostic value of (18)F-FDG PET/CT qualitative therapy assessment (Hopkins criteria) in patients with head and neck squamous cell carcinomas (HNSCCs) with residual neck nodes after definitive chemoradiation therapy and compares the Hopkins criteria with anatomic nodal size and morphologic features for prediction of survival outcomes. MATERIALS AND METHODS: A total of 72 patients with HNSCC, with negative primary tumor and positive residual neck nodes (CT criteria > 1 cm short-axis diameter) after the completion of definitive chemoradiation therapy, were included. PET/CT was performed 6-24 weeks after completion of treatment. FDG uptake in residual nodes on PET/CT was interpreted using a structured qualitative 5-point scale (Hopkins criteria). The 5-point scale was dichotomized to negative (scores 1, 2, and 3) or positive (scores 4 and 5) results. Cystic or necrotic nodes were defined as those with central low attenuation with a relatively hyperdense capsule. Kaplan-Meier curve and Cox regression analysis were performed. RESULTS: On the basis of the Hopkins criteria, 10 (13.9%) patients had positive findings and 62 (86.1%) had negative findings for residual nodal disease. According to CT interpretation, 25 patients (34.7%) had residual cervical lymph nodes greater than or equal to 1.5 cm in diameter, and 41 (56.9%) patients had cystic or necrotic nodes. Patients were followed for a median of 27 months after posttherapy PET/CT. There was a statistically significant difference in overall survival (OS) (hazard ratio, 7.06; p < 0.001) and progression-free survival (PFS) (hazard ratio, 6.18; p < 0.001) between patients with negative versus positive residual FDG nodal uptake. There was no statistically significant difference in OS and PFS in patients categorized on the basis of nodal size or morphologic features. CONCLUSION: PET-based structured qualitative therapy assessment (Hopkins criteria) can predict survival outcomes of patients with HNSCC with residual neck nodes after definitive chemoradiotherapy.
Entities:
Keywords:
CT; PET/CT; head and neck squamous cell carcinoma; survival; therapy assessment
Authors: Alexander J Towbin; Rebecka L Meyers; Helen Woodley; Osamu Miyazaki; Christopher B Weldon; Bruce Morland; Eiso Hiyama; Piotr Czauderna; Derek J Roebuck; Greg M Tiao Journal: Pediatr Radiol Date: 2018-02-09
Authors: P Bonomo; A Merlotti; S Morbelli; V Berti; C Saieva; F Bergesio; A Bacigalupo; L Belgioia; C Franzese; E Lopci; A Casolo; E D'Angelo; D Alterio; L Travaini; L Berretta; V Pirro; S Ursino; D Volterrani; M Roncali; F Vigo; S Cicchetti; F Scalone; G Belli; S Cauda; I Desideri; E Russi; L Livi; A Bianchi Journal: Eur J Hybrid Imaging Date: 2020-05-26