Prognostic implications of post-therapy 18F-FDG PET in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy

Sheng Chieh Chan, Wen Han Kuo, Hung Ming Wang, Joseph Tung Chieh Chang, Chien Yu Lin, Shu Hang Ng, Cheng Lung Hsu, Kai Ping Chang, Chun Ta Liao, Yu Jr Lin, Tzu Chen Yen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

14 Scopus citations

Abstract

Objectives: Reliable prognostic factors that serve as a guide to follow-up of patients with locoregionally advanced nasopharyngeal carcinoma (NPC) have not yet been identified. We sought to investigate the prognostic implications of post-therapy PET in patients with NPC treated with chemoradiotherapy. Methods: Patients with locoregionally advanced NPC (stages III and IVa-b) who had completed primary curative treatment for 3 months were eligible. All of the patients underwent 18F-FDG PET and conventional work-up (CWU) for the assessment of treatment response. Results: A total of 165 patients were enrolled. Over a median follow-up of 58 months, 30 patients died and 41 had disease recurrence. The results of the 3-month post-therapy PET and total lesion glycolysis (TLG) of the primary tumor were independent predictors of overall survival. TNM tumor stage, TLG, and post-therapy PET findings were independently associated with disease-free survival (DFS). The results of post-therapy PET were more predictive of DFS than TNM tumor stage (P < 0.001 vs. P = 0.005). Among patients with stage IVa-b disease, there was a trend toward better 5-DFS rates in patients with a complete metabolic response (CMR) on PET than in those who showed a complete response in the CWU (5-year DFS = 70.7 vs. 63.1 %). Notably, the 1- and 2-year DFS rates were significantly better in the former group compared with the latter. In contrast, the results of post-therapy CWU were not a reliable predictor for DFS. Conclusion: The results of post-therapy PET are an important independent prognostic factor in locoregionally advanced NPC. CMR on PET is associated with better DFS rates and could serve as a guidance to individualize the surveillance protocols for patients with stage IVa-b disease.

Original languageEnglish
Pages (from-to)710-719
Number of pages10
JournalAnnals of Nuclear Medicine
Volume27
Issue number8
DOIs
StatePublished - 10 2013

Keywords

  • FDG
  • Head and neck cancer
  • Nasopharyngeal carcinoma
  • PET
  • Prognosis
  • Surveillance
  • Treatment response

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