Nils Helsen1,2, Tim Van den Wyngaert3,4, Laurens Carp3,4, Remco De Bree5,6, Olivier M VanderVeken4,7, Frank De Geeter8, Alex Maes9, Jean-Philippe Cambier10, Karoline Spaepen11, Michel Martens12, Sara Hakim5, Laurence Beels9, Otto S Hoekstra5, Danielle Van den Weyngaert13, Sigrid Stroobants3,4, Carl Van Laer, Pol Specenier, Annelies Maes, Philip Debruyne, Isabel Hutsebaut, Joost Van Dinter, Filip Homans, Laurence Goethals, Oliver Lenssen, Kristof Deben. 1. Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium. nilshelsen@hotmail.com. 2. Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium. nilshelsen@hotmail.com. 3. Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium. 4. Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium. 5. Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 6. Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. 7. Department Otorhinolaryngology, and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium. 8. Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium. 9. Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium. 10. Department of Nuclear Medicine, Jessa Hospital, Hasselt, Belgium. 11. Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium. 12. Department of radiotherapy, AZ Turnhout, Turnhout, Belgium. 13. Department of radiotherapy, ZNA Middelheim, Antwerp, Belgium.
Abstract
BACKGROUND: The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed. METHODS: SUVbody weight thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127). RESULTS: In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV70 threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-to-background ratios, an SUV50/SUVliver threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV70 and SUV50/SUVliver provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV70 = 0.93, SUV50/SUVliver = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant). CONCLUSION: FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV70 threshold 2.2) prove robust, yet ratios (SUV50/SUVliver, threshold 0.96) may be more useful in routine clinical care. In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria. TRIAL REGISTRATION: US National Library for Medicine, NCT01179360. Registered 11 August 2010, https://clinicaltrials.gov/ct2/show/NCT01179360.
BACKGROUND: The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed. METHODS: SUVbody weight thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127). RESULTS: In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV70 threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-to-background ratios, an SUV50/SUVliver threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV70 and SUV50/SUVliver provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV70 = 0.93, SUV50/SUVliver = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant). CONCLUSION: FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV70 threshold 2.2) prove robust, yet ratios (SUV50/SUVliver, threshold 0.96) may be more useful in routine clinical care. In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria. TRIAL REGISTRATION: US National Library for Medicine, NCT01179360. Registered 11 August 2010, https://clinicaltrials.gov/ct2/show/NCT01179360.
Entities:
Keywords:
18F-fluorodeoxyglucose; Chemoradiotherapy; Standard uptake value (SUV)
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