Mayo Zachary, Seyedin Steven N, Mallak Nadine, Mott Sarah L, Menda Yusuf, Graham Michael, Anderson Carryn
1 Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
2 Department of Nuclear Medicine and PET Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Ann Otol Rhinol Laryngol. 2019 Jul;128(7):595-600. doi: 10.1177/0003489419834312. Epub 2019 Feb 27.
The aim of this study was to investigate the utility of pretreatment and 3-month F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) standardized uptake value (SUV) in predicting and assessing recurrence in T3-T4 laryngeal carcinoma treated with definitive radiation therapy (RT).
Patients with newly diagnosed T3-T4 laryngeal squamous cell carcinoma treated with definitive RT from 2004 to 2014 were reviewed. Patients who underwent pretreatment or 3-month PET/CT 2 to 4 months after treatment were included. Those with prior systemic, surgical, or RT treatment were excluded. The primary objective was to assess whether pretreatment or posttreatment maximum SUV of the primary site (pSUV) of disease was associated with local recurrence-free survival. Overall survival was a secondary end point. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to assess the accuracy of 3-month PET/CT at the larynx primary.
Twenty-eight patients were eligible for analysis. Median follow-up time was 34.7 months (range, 5.3-138.7 months), and median age was 57 years. Most patients had supraglottic (71.4%), T3 (89.3%), N2 (50.0%) disease, received chemotherapy (96.4%), and had histories of tobacco use (96.4%). On univariate analysis, 3-month posttreatment pSUV was associated with local recurrence-free survival ( P < .01), while pretreatment pSUV was not ( P = .41). No other associations were found with local recurrence-free survival. Neither pretreatment nor 3-month pSUV was significantly associated with overall survival. The calculated sensitivity, specificity, positive predictive value, and negative predictive value of 3-month PET/CT at the primary site were 33%, 85%, 40%, and 81%, respectively.
High initial fluorodeoxyglucose uptake in T3-T4 laryngeal primaries did not show an association with the risk for postradiation local relapse or overall survival, while increased fluorodeoxyglucose uptake at 3 months was associated with increased local recurrence. At 3 months, the relatively low sensitivity and positive predictive value may limit the utility of PET/CT in the assessment of persistent advanced laryngeal cancer after definitive radiation.
本研究旨在探讨治疗前及3个月时的F-氟脱氧葡萄糖正电子发射断层扫描（PET）/计算机断层扫描（CT）标准化摄取值（SUV）在预测和评估接受根治性放射治疗（RT）的T3-T4期喉癌复发中的作用。
回顾性分析2004年至2014年接受根治性RT治疗的新诊断T3-T4期喉鳞状细胞癌患者。纳入治疗前或治疗后2至4个月接受3个月PET/CT检查的患者。排除既往接受过全身治疗、手术治疗或RT治疗的患者。主要目的是评估疾病原发部位的治疗前或治疗后最大SUV（pSUV）是否与无局部复发生存相关。总生存是次要终点。计算敏感性、特异性、阳性预测值和阴性预测值，以评估3个月PET/CT对喉原发灶的准确性。
28例患者符合分析条件。中位随访时间为34.7个月（范围5.3-138.7个月），中位年龄为57岁。大多数患者为声门上型（71.4%）、T3期（89.3%）、N2期（50.0%）疾病，接受过化疗（96.4%），有吸烟史（96.4%）。单因素分析显示，治疗后3个月的pSUV与无局部复发生存相关（P<.01），而治疗前pSUV与无局部复发生存无关（P=0.41）。未发现其他与无局部复发生存相关的因素。治疗前和3个月的pSUV均与总生存无显著相关性。计算得出3个月PET/CT对原发灶的敏感性、特异性、阳性预测值和阴性预测值分别为33%、85%、40%和81%。
T3-T4期喉原发灶较高的初始氟脱氧葡萄糖摄取与放疗后局部复发风险或总生存无相关性，而3个月时氟脱氧葡萄糖摄取增加与局部复发增加相关。3个月时，相对较低的敏感性和阳性预测值可能会限制PET/CT在评估根治性放疗后持续性晚期喉癌中的应用。
