Asphericity as a measure of spatial heterogeneity is superior to SUVmax change as a predictor of therapy outcome in FDG-PET of patients with head and neck cancer

Ziel/Aim:

The prognostic value of SUV is unsatisfactory in head and neck carcinoma. The aim of the present study was to evaluate a new measure of spatial heterogeneity as prognostic factor in FDG PET investigations of this cancer type.

Methodik/Methods:

We define the asphericity of a lesion as ASP=[1/(36*pi)*S^3/V^2]^(1/3)-1 where S is the lesion's surface and V is it's volume. ASP is a dimensionless number having a simple interpretation: ASP represents the fractional increase of the surface of the lesion relative to the surface of a sphere possessing the same volume (i.e. ASP=0 for a spherical lesion). ASP was evaluated retrospectively in 36 FDG PETs of patients with head and neck squamous cell carcinoma prior to chemoradiotherapy. A second FDG PET/CT was performed one to two weeks after start of therapy. The baseline and interim FDG images of the primary tumor were segmented using the ROVER 3D segmentation tool. The change of SUVmax (dSUVmax) of the primary tumor was computed. ASP was computed in the baseline PET. Kaplan-Meier analysis with respect to overall survival (OAS) was performed for dSUVmax and ASP and were compared by log-rank tests.

Ergebnisse/Results:

Mean OAS was 20.7 month. ASP was prognostic for OAS (p=0.0001), as was dSUVmax but with distinctly lower significance (p=0.023). Higher tumor asphericity was associated with reduced survival. Patients with ASP>25% showed a 2-year OAS rate of 12% compared to 74% in patients with ASP < 25%.

Schlussfolgerungen/Conclusions:

ASP of the pretherapeutic FDG uptake pattern in the primary tumor is predictive for survival of patients with head-and-neck carcinoma. It is superior to changes of SUVmax during therapy. This is remarkable since ASP is derived from a single PET scan prior to therapy, while computation of dSUVmax requires at least two PET measurements. Further investigations are necessary to confirm these preliminary results.