Does a 6-point scale approach to posttreatment 18F-FDG PET-CT allow to improve response assessment in head and neck squamous cell carcinoma? A multicenter study

Autor: Pierluigi Bonomo, Egesta Lopci, M. Roncali, Ciro Franzese, L. Berretta, Almalina Bacigalupo, Valentina Berti, S. Cauda, Anna Merlotti, Calogero Saieva, Isacco Desideri, F. Bergesio, V. Pirro, Silvia Morbelli, Elisa D'Angelo, A. Casolo, Elvio G. Russi, Lorenzo Livi, S. Cicchetti, F. Scalone, Stefano Ursino, Gilda Belli, L. Travaini, Liliana Belgioia, Andrea Bianchi, D. Volterrani, F. Vigo, Daniela Alterio
Jazyk: angličtina
Rok vydání: 2020
Předmět:
lcsh:Medical physics. Medical radiology. Nuclear medicine
medicine.medical_specialty
Positive predictive value
Multivariate analysis
F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography
Diagnostic accuracy
Head and neck cancer
Radiotherapy
Head and neck cancer
Radiotherapy
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography
Diagnostic accuracy
Positive predictive value
lcsh:R895-920
medicine.medical_treatment
Biophysics
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Computer Science (miscellaneous)
medicine
Clinical endpoint
Radiology
Nuclear Medicine and imaging
medicine.diagnostic_test
business.industry
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography
medicine.disease
Primary tumor
Head and neck squamous-cell carcinoma
Radiation therapy
Positron emission tomography
030220 oncology & carcinogenesis
Molecular Medicine
Original Article
Radiology
business
Progressive disease
Zdroj: European Journal of Hybrid Imaging
European Journal of Hybrid Imaging, Vol 4, Iss 1, Pp 1-16 (2020)
Popis: Purpose Response assessment to definitive non-surgical treatment for head and neck squamous cell carcinoma (HNSCC) is centered on the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET-CT) 12 weeks after treatment. The 5-point Hopkins score is the only qualitative system available for standardized reporting, albeit limited by suboptimal positive predictive value (PPV). The aim of our study was to explore the feasibility and assess the diagnostic accuracy of an experimental 6-point scale (“Cuneo score”). Methods We performed a retrospective, multicenter study on HNSCC patients who received a curatively-intended, radiation-based treatment. A centralized, independent qualitative evaluation of post-treatment FDG-PET/CT scans was undertaken by 3 experienced nuclear medicine physicians who were blinded to patients’ information, clinical data, and all other imaging examinations. Response to treatment was evaluated according to Hopkins, Cuneo, and Deauville criteria. The primary endpoint of the study was to evaluate the PPV of Cuneo score in assessing locoregional control (LRC). We also correlated semi-quantitative metabolic factors as included in PERCIST and EORTC criteria with disease outcome. Results Out of a total sample of 350 patients from 11 centers, 119 subjects (oropharynx, 57.1%; HPV negative, 73.1%) had baseline and post-treatment FDG-PET/CT scans fully compliant with EANM 1.0 guidelines and were therefore included in our analysis. At a median follow-up of 42 months (range 5-98), the median locoregional control was 35 months (95% CI, 32-43), with a 74.5% 3-year rate. Cuneo score had the highest diagnostic accuracy (76.5%), with a positive predictive value for primary tumor (Tref), nodal disease (Nref), and composite TNref of 42.9%, 100%, and 50%, respectively. A Cuneo score of 5-6 (indicative of residual disease) was associated with poor overall survival at multivariate analysis (HR 6.0; 95% CI, 1.88-19.18; p = 0.002). In addition, nodal progressive disease according to PERCIST criteria was associated with worse LRC (OR for LR failure, 5.65; 95% CI, 1.26-25.46; p = 0.024) and overall survival (OR for death, 4.81; 1.07-21.53; p = 0.04). Conclusions In the frame of a strictly blinded methodology for response assessment, the feasibility of Cuneo score was preliminarily validated. Prospective investigations are warranted to further evaluate its reproducibility and diagnostic accuracy.
Databáze: OpenAIRE
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