P Bonomo1, A Merlotti2, S Morbelli3, V Berti4, C Saieva5, F Bergesio6, A Bacigalupo7, L Belgioia7, C Franzese8, E Lopci9, A Casolo10, E D'Angelo11, D Alterio12, L Travaini13, L Berretta14, V Pirro15, S Ursino16, D Volterrani17, M Roncali18, F Vigo19, S Cicchetti20, F Scalone21, G Belli22, S Cauda23, I Desideri24, E Russi2, L Livi24, A Bianchi25. 1. Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, Largo Brambilla 3,, 50134, Florence, Italy. bonomopierlu@gmail.com. 2. Radiation Oncology, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy. 3. Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 4. Nuclear Medicine, Azienda Ospedaliero - Universitaria Careggi, University of Florence, Florence, Italy. 5. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy. 6. Medical Physics, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy. 7. Radiation Oncology, IRCSS Ospedale Policlinico San Martino, Genoa, Italy. 8. Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital - IRCSS, Rozzano, Milan, Italy. 9. Nuclear Medicine, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy. 10. Nuclear Medicine, University Hospital of Modena, Modena, Italy. 11. Radiation Oncology, University Hospital of Modena, Modena, Italy. 12. Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy. 13. Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy. 14. Radiation Oncology, Azienda Ospedaliera SS Antonio e Biagio e C. Arrigo, Alessandria, Italy. 15. Nuclear Medicine, Azienda Ospedaliera SS Antonio e Biagio e C. Arrigo, Alessandria, Italy. 16. Radiation Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 17. Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 18. Nuclear Medicine, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy. 19. Radiation Oncology, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy. 20. Radiation Oncology, Tor Vergata University Hospital, Rome, Italy. 21. Nuclear Medicine, Tor Vergata University Hospital, Rome, Italy. 22. Radiation Oncology, Candiolo Cancer Institute, FPO- IRCCS, Candiolo, Turin, Italy. 23. Nuclear Medicine, Candiolo Cancer Institute, FPO- IRCCS, Candiolo, Turin, Italy. 24. Radiation Oncology, Azienda Ospedaliero - Universitaria Careggi, University of Florence, Largo Brambilla 3,, 50134, Florence, Italy. 25. Nuclear Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
Abstract
PURPOSE: Response assessment to definitive non-surgical treatment for head and neck squamous cell carcinoma (HNSCC) is centered on the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET-CT) 12 weeks after treatment. The 5-point Hopkins score is the only qualitative system available for standardized reporting, albeit limited by suboptimal positive predictive value (PPV). The aim of our study was to explore the feasibility and assess the diagnostic accuracy of an experimental 6-point scale ("Cuneo score"). METHODS: We performed a retrospective, multicenter study on HNSCC patients who received a curatively-intended, radiation-based treatment. A centralized, independent qualitative evaluation of post-treatment FDG-PET/CT scans was undertaken by 3 experienced nuclear medicine physicians who were blinded to patients' information, clinical data, and all other imaging examinations. Response to treatment was evaluated according to Hopkins, Cuneo, and Deauville criteria. The primary endpoint of the study was to evaluate the PPV of Cuneo score in assessing locoregional control (LRC). We also correlated semi-quantitative metabolic factors as included in PERCIST and EORTC criteria with disease outcome. RESULTS: Out of a total sample of 350 patients from 11 centers, 119 subjects (oropharynx, 57.1%; HPV negative, 73.1%) had baseline and post-treatment FDG-PET/CT scans fully compliant with EANM 1.0 guidelines and were therefore included in our analysis. At a median follow-up of 42 months (range 5-98), the median locoregional control was 35 months (95% CI, 32-43), with a 74.5% 3-year rate. Cuneo score had the highest diagnostic accuracy (76.5%), with a positive predictive value for primary tumor (Tref), nodal disease (Nref), and composite TNref of 42.9%, 100%, and 50%, respectively. A Cuneo score of 5-6 (indicative of residual disease) was associated with poor overall survival at multivariate analysis (HR 6.0; 95% CI, 1.88-19.18; p = 0.002). In addition, nodal progressive disease according to PERCIST criteria was associated with worse LRC (OR for LR failure, 5.65; 95% CI, 1.26-25.46; p = 0.024) and overall survival (OR for death, 4.81; 1.07-21.53; p = 0.04). CONCLUSIONS: In the frame of a strictly blinded methodology for response assessment, the feasibility of Cuneo score was preliminarily validated. Prospective investigations are warranted to further evaluate its reproducibility and diagnostic accuracy.
PURPOSE: Response assessment to definitive non-surgical treatment for head and neck squamous cell carcinoma (HNSCC) is centered on the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET-CT) 12 weeks after treatment. The 5-point Hopkins score is the only qualitative system available for standardized reporting, albeit limited by suboptimal positive predictive value (PPV). The aim of our study was to explore the feasibility and assess the diagnostic accuracy of an experimental 6-point scale ("Cuneo score"). METHODS: We performed a retrospective, multicenter study on HNSCCpatients who received a curatively-intended, radiation-based treatment. A centralized, independent qualitative evaluation of post-treatment FDG-PET/CT scans was undertaken by 3 experienced nuclear medicine physicians who were blinded to patients' information, clinical data, and all other imaging examinations. Response to treatment was evaluated according to Hopkins, Cuneo, and Deauville criteria. The primary endpoint of the study was to evaluate the PPV of Cuneo score in assessing locoregional control (LRC). We also correlated semi-quantitative metabolic factors as included in PERCIST and EORTC criteria with disease outcome. RESULTS: Out of a total sample of 350 patients from 11 centers, 119 subjects (oropharynx, 57.1%; HPV negative, 73.1%) had baseline and post-treatment FDG-PET/CT scans fully compliant with EANM 1.0 guidelines and were therefore included in our analysis. At a median follow-up of 42 months (range 5-98), the median locoregional control was 35 months (95% CI, 32-43), with a 74.5% 3-year rate. Cuneo score had the highest diagnostic accuracy (76.5%), with a positive predictive value for primary tumor (Tref), nodal disease (Nref), and composite TNref of 42.9%, 100%, and 50%, respectively. A Cuneo score of 5-6 (indicative of residual disease) was associated with poor overall survival at multivariate analysis (HR 6.0; 95% CI, 1.88-19.18; p = 0.002). In addition, nodal progressive disease according to PERCIST criteria was associated with worse LRC (OR for LR failure, 5.65; 95% CI, 1.26-25.46; p = 0.024) and overall survival (OR for death, 4.81; 1.07-21.53; p = 0.04). CONCLUSIONS: In the frame of a strictly blinded methodology for response assessment, the feasibility of Cuneo score was preliminarily validated. Prospective investigations are warranted to further evaluate its reproducibility and diagnostic accuracy.
Entities:
Keywords:
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography; Diagnostic accuracy; Head and neck cancer; Positive predictive value; Radiotherapy
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