What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis

• Published in: European journal of nuclear medicine and molecular imaging Vol. 45; no. 12; pp. 2122 - 2138
• Main Authors: Bonomo, Pierluigi, Merlotti, A., Olmetto, E., Bianchi, A., Desideri, I., Bacigalupo, A., Franco, P., Franzese, C., Orlandi, E., Livi, L., Caini, S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2018; Springer Nature B.V
• Subjects: Cardiology; Chemoradiotherapy; Disease control; Fluorodeoxyglucose F18; Head & neck cancer; Heterogeneity; Humans; Imaging; Literature reviews; Medical prognosis; Medicine; Medicine & Public Health; Meta-analysis; Metabolism; Nuclear Medicine; Oncology; Original; Original Article; Oropharynx; Orthopedics; Parameters; Patients; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Prognosis; Radiation therapy; Radiology; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - diagnostic imaging; Squamous Cell Carcinoma of Head and Neck - pathology; Squamous Cell Carcinoma of Head and Neck - therapy; Statistical analysis; Survival; Systematic review; Tomography; Tumors; Head and neck cancer; Radiotherapy; F-Fluorodeoxyglucose (FDG) positron emission tomography; Metabolic tumour volume; 18F-Fluorodeoxyglucose (FDG) positron emission tomography
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-018-4065-5

Purpose Evidence is conflicting on the prognostic value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of our study was to determine the impact of semiquantitative and qualitative metabolic parameters on the outcome in patients managed with standard treatment for locally advanced disease. Methods A systematic review of the literature was conducted. A meta-analysis was performed of studies providing estimates of relative risk (RR) for the association between semiquantitative metabolic parameters and efficacy outcome measures. Results The analysis included 25 studies, for a total of 2,223 subjects. The most frequent primary tumour site was the oropharynx (1,150/2,223 patients, 51.7%). According to the available data, the majority of patients had stage III/IV disease (1,709/1,799, 94.9%; no information available in four studies) and were treated with standard concurrent chemoradiotherapy (1,562/2,009 patients, 77.7%; only one study without available information). A total of 11, 8 and 4 independent studies provided RR estimates for the association between baseline FDG PET metrics and overall survival (OS), progression-free survival (PFS) and locoregional control (LRC), respectively. High pretreatment metabolic tumour volume (MTV) was significantly associated with a worse OS (summary RR 1.86, 95% CI 1.08–3.21), PFS (summary RR 1.81, 95% CI 1.14–2.89) and LRC (summary RR 3.49, 95% CI 1.65–7.35). Given the large heterogeneity ( I 2  > 50%) affecting the summary measures, no cumulative threshold for an unfavourable prognosis could be defined. No statistically significant association was found between SUV max and any of the outcome measures. Conclusion FDG PET has prognostic relevance in the context of locally advanced head and neck squamous cell carcinoma. Pretreatment MTV is the only metabolic variable with a significant impact on patient outcome. Because of the heterogeneity and the lack of standardized methodology, no definitive conclusions on optimal cut-off values can be drawn.