Prospective risk-adjusted [18F]fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer

Benjamin J. Moeller, Vishal Rana, Blake A. Cannon, Michelle D. Williams, Erich M. Sturgis, Lawrence E. Ginsberg, Homer A. Macapinlac, J. Jack Lee, K. Kian Ang, K. S Clifford Chao, Gregory M. Chronowski, Steven J. Frank, William H. Morrison, David I. Rosenthal, Randal S. Weber, Adam S. Garden, Scott M. Lippman, David L. Schwartz

Research output: Contribution to journalArticle

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Abstract

Purpose: [18F]Fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) imaging may improve assessment of radiation response in patients with head and neck cancer, but it is not yet known for which patients this is most useful. We conducted a prospective trial to identify patient populations likely to benefit from the addition of functional imaging to the assessment of radiotherapy response. Patients and Methods: Ninety-eight patients with locally advanced cancer of the oropharynx, larynx, or hypopharynx were prospectively enrolled and treated with primary radiotherapy, with or without chemotherapy. Patients underwent FDG-PET/CT and contrast-enhanced CT imaging 8 weeks after completion of treatment. Functional and anatomic imaging response was correlated with clinical and pathologic response. Imaging accuracy was then compared between imaging modalities. Results: Although postradiation maximum standard uptake values were significantly higher in nonresponders compared with responders, the positive and negative predictive values of FDG-PET/CT scanning were similar to those for CT alone in the unselected study population. Subset analyses revealed that FDG-PET/CT outperformed CT alone in response assessment for patients at high risk for treatment failure (those with human papillomavirus [HPV] -negative disease, nonoropharyngeal primaries, or history of tobacco use). No benefit to FDG-PET/CT was seen for low-risk patients lacking these features. Conclusion: These data do not support the broad application of FDG-PET/CT for radiation response assessment in unselected head and neck cancer patients. However, FDG-PET/CT may be the imaging modality of choice for patients with highest risk disease, particularly those with HPV-negative tumors. Optimal timing of FDG-PET/CT imaging after radiotherapy merits further investigation.

Original languageEnglish (US)
Pages (from-to)2509-2515
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number15
DOIs
StatePublished - May 20 2009

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Fluorodeoxyglucose F18
Head and Neck Neoplasms
Radiation
Radiotherapy
Tomography
Positron Emission Tomography Computed Tomography
Oropharyngeal Neoplasms
Hypopharynx
Laryngeal Neoplasms
Tobacco Use
Treatment Failure
Population
Drug Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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Prospective risk-adjusted [18F]fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. / Moeller, Benjamin J.; Rana, Vishal; Cannon, Blake A.; Williams, Michelle D.; Sturgis, Erich M.; Ginsberg, Lawrence E.; Macapinlac, Homer A.; Lee, J. Jack; Ang, K. Kian; Chao, K. S Clifford; Chronowski, Gregory M.; Frank, Steven J.; Morrison, William H.; Rosenthal, David I.; Weber, Randal S.; Garden, Adam S.; Lippman, Scott M.; Schwartz, David L.

In: Journal of Clinical Oncology, Vol. 27, No. 15, 20.05.2009, p. 2509-2515.

Research output: Contribution to journalArticle

Moeller, BJ, Rana, V, Cannon, BA, Williams, MD, Sturgis, EM, Ginsberg, LE, Macapinlac, HA, Lee, JJ, Ang, KK, Chao, KSC, Chronowski, GM, Frank, SJ, Morrison, WH, Rosenthal, DI, Weber, RS, Garden, AS, Lippman, SM & Schwartz, DL 2009, 'Prospective risk-adjusted [18F]fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer', Journal of Clinical Oncology, vol. 27, no. 15, pp. 2509-2515. https://doi.org/10.1200/JCO.2008.19.3300
Moeller, Benjamin J. ; Rana, Vishal ; Cannon, Blake A. ; Williams, Michelle D. ; Sturgis, Erich M. ; Ginsberg, Lawrence E. ; Macapinlac, Homer A. ; Lee, J. Jack ; Ang, K. Kian ; Chao, K. S Clifford ; Chronowski, Gregory M. ; Frank, Steven J. ; Morrison, William H. ; Rosenthal, David I. ; Weber, Randal S. ; Garden, Adam S. ; Lippman, Scott M. ; Schwartz, David L. / Prospective risk-adjusted [18F]fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. In: Journal of Clinical Oncology. 2009 ; Vol. 27, No. 15. pp. 2509-2515.
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abstract = "Purpose: [18F]Fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) imaging may improve assessment of radiation response in patients with head and neck cancer, but it is not yet known for which patients this is most useful. We conducted a prospective trial to identify patient populations likely to benefit from the addition of functional imaging to the assessment of radiotherapy response. Patients and Methods: Ninety-eight patients with locally advanced cancer of the oropharynx, larynx, or hypopharynx were prospectively enrolled and treated with primary radiotherapy, with or without chemotherapy. Patients underwent FDG-PET/CT and contrast-enhanced CT imaging 8 weeks after completion of treatment. Functional and anatomic imaging response was correlated with clinical and pathologic response. Imaging accuracy was then compared between imaging modalities. Results: Although postradiation maximum standard uptake values were significantly higher in nonresponders compared with responders, the positive and negative predictive values of FDG-PET/CT scanning were similar to those for CT alone in the unselected study population. Subset analyses revealed that FDG-PET/CT outperformed CT alone in response assessment for patients at high risk for treatment failure (those with human papillomavirus [HPV] -negative disease, nonoropharyngeal primaries, or history of tobacco use). No benefit to FDG-PET/CT was seen for low-risk patients lacking these features. Conclusion: These data do not support the broad application of FDG-PET/CT for radiation response assessment in unselected head and neck cancer patients. However, FDG-PET/CT may be the imaging modality of choice for patients with highest risk disease, particularly those with HPV-negative tumors. Optimal timing of FDG-PET/CT imaging after radiotherapy merits further investigation.",
author = "Moeller, {Benjamin J.} and Vishal Rana and Cannon, {Blake A.} and Williams, {Michelle D.} and Sturgis, {Erich M.} and Ginsberg, {Lawrence E.} and Macapinlac, {Homer A.} and Lee, {J. Jack} and Ang, {K. Kian} and Chao, {K. S Clifford} and Chronowski, {Gregory M.} and Frank, {Steven J.} and Morrison, {William H.} and Rosenthal, {David I.} and Weber, {Randal S.} and Garden, {Adam S.} and Lippman, {Scott M.} and Schwartz, {David L.}",
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T1 - Prospective risk-adjusted [18F]fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer

AU - Moeller, Benjamin J.

AU - Rana, Vishal

AU - Cannon, Blake A.

AU - Williams, Michelle D.

AU - Sturgis, Erich M.

AU - Ginsberg, Lawrence E.

AU - Macapinlac, Homer A.

AU - Lee, J. Jack

AU - Ang, K. Kian

AU - Chao, K. S Clifford

AU - Chronowski, Gregory M.

AU - Frank, Steven J.

AU - Morrison, William H.

AU - Rosenthal, David I.

AU - Weber, Randal S.

AU - Garden, Adam S.

AU - Lippman, Scott M.

AU - Schwartz, David L.

PY - 2009/5/20

Y1 - 2009/5/20

N2 - Purpose: [18F]Fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) imaging may improve assessment of radiation response in patients with head and neck cancer, but it is not yet known for which patients this is most useful. We conducted a prospective trial to identify patient populations likely to benefit from the addition of functional imaging to the assessment of radiotherapy response. Patients and Methods: Ninety-eight patients with locally advanced cancer of the oropharynx, larynx, or hypopharynx were prospectively enrolled and treated with primary radiotherapy, with or without chemotherapy. Patients underwent FDG-PET/CT and contrast-enhanced CT imaging 8 weeks after completion of treatment. Functional and anatomic imaging response was correlated with clinical and pathologic response. Imaging accuracy was then compared between imaging modalities. Results: Although postradiation maximum standard uptake values were significantly higher in nonresponders compared with responders, the positive and negative predictive values of FDG-PET/CT scanning were similar to those for CT alone in the unselected study population. Subset analyses revealed that FDG-PET/CT outperformed CT alone in response assessment for patients at high risk for treatment failure (those with human papillomavirus [HPV] -negative disease, nonoropharyngeal primaries, or history of tobacco use). No benefit to FDG-PET/CT was seen for low-risk patients lacking these features. Conclusion: These data do not support the broad application of FDG-PET/CT for radiation response assessment in unselected head and neck cancer patients. However, FDG-PET/CT may be the imaging modality of choice for patients with highest risk disease, particularly those with HPV-negative tumors. Optimal timing of FDG-PET/CT imaging after radiotherapy merits further investigation.

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