Alaa Mouminah1,2, Austin J Borja1,3, Emily C Hancin1,4, Yu Cheng Chang2, Thomas J Werner1, Samuel Swisher-McClure5, Jonathan Korostoff2, Abass Alavi1, Mona-Elisabeth Revheim6,7,8. 1. Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. 2. The University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA. 3. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 4. Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA. 5. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA. 6. Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. mona.elisabeth.revheim@ous-hf.no. 7. Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway. mona.elisabeth.revheim@ous-hf.no. 8. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. mona.elisabeth.revheim@ous-hf.no.
Abstract
BACKGROUND: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used in the clinical management of oncologic and inflammatory pathologies. It may have utility in detecting radiotherapy (RT)-induced damage of oral tissues. Thus, the aim of the present study was to use FDG-PET/CT to evaluate parotid gland inflammation following RT in patients with head and neck cancer (HNC). METHODS: This retrospective study included patients with HNC treated with photon, proton, or combined photon/proton RT, in addition to chemotherapy. All patients received FDG-PET/CT imaging pre-treatment and 3 months post-treatment. The average mean standardized uptake value (Avg SUVmean) and the average maximum standardized uptake value (Avg SUVmax) of the left and right parotid glands were determined by global assessment of FDG activity using OsiriX MD software. A two-tailed paired t test was used to compare Avg SUVmean and Avg SUVmax pre- and post-RT. RESULTS: Forty-seven HNC patients were included in the study. Parotid gland Avg SUVmean was significantly higher at 3 months post-treatment than pre-treatment (p < 0.05) in patients treated with photon RT, but no significant differences were found between pre- and post-treatment Avg SUVmean in patients treated with proton RT or combined photon/proton RT. CONCLUSION: Our results suggest that photon RT may cause radiation-induced inflammation of the parotid gland, and that proton RT, which distributes less off-target radiation, is a safer treatment alternative.
BACKGROUND:18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used in the clinical management of oncologic and inflammatory pathologies. It may have utility in detecting radiotherapy (RT)-induced damage of oral tissues. Thus, the aim of the present study was to use FDG-PET/CT to evaluate parotid gland inflammation following RT in patients with head and neck cancer (HNC). METHODS: This retrospective study included patients with HNC treated with photon, proton, or combined photon/proton RT, in addition to chemotherapy. All patients received FDG-PET/CT imaging pre-treatment and 3 months post-treatment. The average mean standardized uptake value (Avg SUVmean) and the average maximum standardized uptake value (Avg SUVmax) of the left and right parotid glands were determined by global assessment of FDG activity using OsiriX MD software. A two-tailed paired t test was used to compare Avg SUVmean and Avg SUVmax pre- and post-RT. RESULTS: Forty-seven HNC patients were included in the study. Parotid gland Avg SUVmean was significantly higher at 3 months post-treatment than pre-treatment (p < 0.05) in patients treated with photon RT, but no significant differences were found between pre- and post-treatment Avg SUVmean in patients treated with proton RT or combined photon/proton RT. CONCLUSION: Our results suggest that photon RT may cause radiation-induced inflammation of the parotid gland, and that proton RT, which distributes less off-target radiation, is a safer treatment alternative.
Entities:
Keywords:
18F-FDG; Head and neck cancer; PET/CT; Parotid gland; Parotid gland inflammation; Radiation therapy
Authors: Austin J Borja; Emily C Hancin; Alexandra D Dreyfuss; Vincent Zhang; Toby Mathew; Chaitanya Rojulpote; Thomas J Werner; Shivaraj Patil; Karthik Gonuguntla; Alexander Lin; Steven J Feigenberg; Samuel Swisher-McClure; Abass Alavi; Mona-Elisabeth Revheim Journal: Am J Nucl Med Mol Imaging Date: 2020-02-25