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Prognostic Value of Head and Neck Tumor Proliferative Sphericity From 3’-Deoxy-3’-[18F] Fluorothymidine Positron Emission Tomography
Majdoub, M.; Hoeben, B.; Troost, E. G. C.; Oyen, W.; Kaanders, J.; Le Rest, C.; Visser, E.; Visvikis, D.; Hatt, M.;
Background: Enhanced proliferative activity in head and neck squamous cell carcinoma (HNSCC) adversely affects outcome after (chemo)radiotherapy. 3’-deoxy-3’-[18F] fluorothymidine (18F-FLT) positron emission tomography (PET) can be used for quantifying tumour proliferation and its changes during therapy. In this study, we investigated the complementary prognostic value of sphericity and standard metrics in 18F-FLT PET images before and during (chemo)radiotherapy regarding 4-year disease-free survival (DFS).
Methods: 48 HNSCC patients treated with radiotherapy (n=32) or chemoradiotherapy (n=16) with curative intent, underwent 18F-FLT PET-CT scans before and in the second week of treatment. Patients were followed for a median of 52 months. Primary tumours were delineated using the Fuzzy Locally Adaptive Bayesian algorithm. The proliferative volumes were further characterized by extracting SUV, volume and sphericity. Prognostic value for disease-free survival (DFS) of features was assessed using Kaplan-Meier survival analysis.
Results: In univariate analysis, the per-treatment sphericity (p=0.02, HR=4.2 [1.3– 13.9]) and SUVmean (p=0.03, HR=4.1 [1.2 – 14.2]) were prognostic factors, whereas none of the pre-treatment features were significant. Reduction in SUVmax (p=0.04, HR=4 [1.1 – 15.1]) was also a prognostic factor, but reduction of proliferative tumour volume did not reach statistical significance. The best stratification of patients for DFS was achieved with the combination of the two per-treatment features SUVmean and sphericity (p<0.001, HR=6.7 [1.8 – 25]).
Conclusion: High sphericity combined with low mean 18F-FLT SUV during treatment were associated with better DFS. These results suggest the potential prognostic value of advanced tumour proliferative volume characterization from 18F-FLT PET in HNSCC that may be further explored in larger cohorts.

Publ.-Id: 26657 - Permalink