2017 Section 7 Green Book

Clinical Review & Education Review

Use of FDG-PET/CT in Oropharyngeal Squamous Cell Carcinoma

lesions were significant prognostic factors for DFS, DSS, or OS, in multivariate Cox regression analysis only MTV for total tumor lesions remained an independent prognostic factor of DFS, DSS, and OS. On the other hand, Moon et al 46 reported that TLG is the only independent prognostic factor in tonsil SCC. Total lesion gly- colysis is a combination of SUV and MTV and represents the meta- bolically active tumor uptake and size; therefore, it is theoretically reasonable that TLG is an ideal parameter of tumor burden 46 (eTable 4 in the Supplement ). Today, it seems that a scoring system is needed to use clinically for prognosis prediction for each kind of head and neck cancer given that they behave differently. Conclusions 18 F-fludeoxyglucose–positron emission tomography/computed to- mography is a vital tool in the management of patients with oro- pharyngealsquamouscellcarcinomaandishelpfulinstaging,therapy planning, evaluating therapy response, detecting recurrence, and predicting prognosis of these patients.

Other PET parameters evaluated to predict prognosis are volume-based measurements such as TLG and MTV. These factors can indicate total activity and volume of metabolically active tumor cells. Multiple studies have shown that MTV and TLG are important prognostic factors in OPSCC, independent of the stage of disease. 47 Garsa et al 13 reported that primary tumor MTV was a sig- nificant predictor of OS and DFS whereas primary tumor TLG was related only to OS. Although total MTV (including LN MTV) and total TLG were significant predictors of DFS and OS, there was no difference between PET parameters in HPV-positive and HPV-negative patients. Cheng et al 48 reported that TLG and unifor- mity (also called angular second moment , a measure of image homogeneity that is extracted from the normalized gray-level co-occurrence matrix) were independently associated with PFS and DSS, whereas MTV and uniformity were associated just with OS. In another study, Cheng et al 49 showed that primary tumor TLG in both HPV-positive and HPV-negative patients with OPSCC is a prognostic factor for OS, PFS, and DFS but nodal TLG is significant just for DFS. Kikuchi et al, 50 who evaluated OPSCC, claimed that although MTV and TLG of primary lesions, LNs, and total tumor

ARTICLE INFORMATION Submitted for Publication: July 13, 2015; accepted July 30, 2015. Published Online: November 19, 2015. doi: 10.1001/jamaoto.2015.2607 . Author Affiliations: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Taghipour, Sheikhbahaei, Marashdeh, Solnes, Subramaniam); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Kiess); Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland (Kiess, Subramaniam); Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland (Subramaniam); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Subramaniam). Author Contributions: Dr Subramaniam had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Taghipour, Sheikhbahaei, Solnes, Subramaniam. Acquisition, analysis, or interpretation of data: Marashdeh, Kiess. Critical revision of the manuscript for important intellectual content: Sheikhbahaei, Marashdeh, Solnes, Kiess, Subramaniam. Administrative, technical, or material support: Taghipour, Sheikhbahaei. Study supervision: Marashdeh, Kiess, Subramaniam. Conflict of Interest Disclosures: None reported. REFERENCES 1 . Kawakita D, Masui T, Hanai N, et al. Impact of positron emission tomography with the use of fluorodeoxyglucose on response to induction chemotherapy in patients with oropharyngeal and Drafting of the manuscript: Taghipour, Sheikhbahaei, Marashdeh, Subramaniam.

10 . Chepeha DB, Sacco AG, Oxford LE, et al. Advanced squamous cell carcinoma of the oropharynx: efficacy of positron emission tomography and computed tomography for determining primary tumor response during induction chemotherapy. Head Neck . 2009;31(4): 452-460 . 11 . Dammann F, Horger M, Mueller-Berg M, et al. Rational diagnosis of squamous cell carcinoma of the head and neck region: comparative evaluation of CT, MRI, and 18FDG PET [published correction appears in AJR Am J Roentgenol . 2005;184(6): 1968]. AJR Am J Roentgenol . 2005;184(4):1326-1331 . 12 . Zafereo ME. Evaluation and staging of squamous cell carcinoma of the oral cavity and oropharynx: limitations despite technological breakthroughs. Otolaryngol Clin North Am . 2013;46 (4):599-613 . 13 . Garsa AA, Chang AJ, Dewees T, et al. Prognostic value of 18 F-FDG PET metabolic parameters in oropharyngeal squamous cell carcinoma. J Radiat Oncol . 2013;2(1):27-34 . 14 . Joo YH, Yoo IeR, Cho KJ, et al. Relationship between extracapsular spread and FDG PET/CT in oropharyngeal squamous cell carcinoma. Acta Otolaryngol . 2013;133(10):1073-1079 . 15 . Kyzas PA, Evangelou E, Denaxa-Kyza D, Ioannidis JP. 18 F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in patients with head and neck squamous cell carcinoma: a meta-analysis. J Natl Cancer Inst . 2008;100(10):712-720 . 16 . Krabbe CA, Dijkstra PU, Pruim J, et al. FDG PET in oral and oropharyngeal cancer: value for confirmation of N0 neck and detection of occult metastases. Oral Oncol . 2008;44(1):31-36 . 17 . Murakami R, Uozumi H, Hirai T, et al. Impact of FDG-PET/CT imaging on nodal staging for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys . 2007;68(2):377-382 . 18 . Piao Y, Bold B, Tayier A, et al. Evaluation of 18F-FDG PET/CT for diagnosing cervical nodal metastases in patients with oral cavity or

hypopharyngeal squamous cell carcinoma. Acta Otolaryngol . 2013;133(5):523-530 . 2 . Paidpally V, Chirindel A, Lam S, Agrawal N, Quon H, Subramaniam RM. FDG-PET/CT imaging biomarkers in head and neck squamous cell carcinoma. Imaging Med . 2012;4(6):633-647 . 3 . Dibble EH, Alvarez AC, Truong MT, Mercier G, Cook EF, Subramaniam RM. 18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: adding value to clinical staging. J Nucl Med . 2012;53 (5):709-715 . 4 . Krabbe CA, Balink H, Roodenburg JL, Dol J, de Visscher JG. Performance of 18F-FDG PET/contrast-enhanced CT in the staging of squamous cell carcinoma of the oral cavity and oropharynx. Int J Oral Maxillofac Surg . 2011;40(11): 1263-1270 . 5 . Marur S, D’Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol . 2010;11(8):781-789 . 6 . Tahari AK, Alluri KC, Quon H, Koch W, Wahl RL, Subramaniam RM. FDG PET/CT imaging of oropharyngeal squamous cell carcinoma: characteristics of human papillomavirus-positive and -negative tumors. Clin Nucl Med . 2014;39(3): 225-231 . 7 . O’Rorke MA, Ellison MV, Murray LJ, Moran M, James J, Anderson LA. Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis. Oral Oncol . 2012;48(12): 1191-1201 . 8 . Parikh U, Marcus C, Sarangi R, Taghipour M, Subramaniam RM. FDG PET/CT in pancreatic and hepatobiliary carcinomas: value to patient management and patient outcomes. PET Clin . 2015; 10(3):327-343 . 9 . Marcus C, Marashdeh W, Ahn SJ, Taghipour M, Subramaniam RM. ¹⁸ F-FDG PET/CT and colorectal cancer: value of fourth and subsequent posttherapy follow-up scans for patient management. J Nucl Med . 2015;56(7):989-994 .

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