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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 al13 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 al48 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
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 al46 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 burden46
(eTable 4 in th . 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
18F-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.
ARTICLE INFORMATION
Submitted for Publication: July 13, 2015; accepted
July 30, 2015.
Published Online: November 19, 2015.
doi
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.
Drafting of the manuscript: Taghipour,
Sheikhbahaei, Marashdeh, Subramaniam.
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.
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Clinical Review & Education Review Use of FDG-PET/CT in Oropharyngeal Squamous Cell Carcinoma
JAMA Otolaryngology–Head & Neck Surgery January 2016 Volume 142, Number 1 (Reprinted)
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