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The Clinical Usefulness of (18)F-Fluorodeoxyglucose Positron Emission Tomography (PET) to Predict Oncologic Outcomes and PET-Based Radiotherapeutic Considerations in Locally Advanced Nasopharyngeal Carcinoma

 Hong In Yoon  ;  Kyung Hwan Kim  ;  Jeongshim Lee  ;  Yun Ho Roh  ;  Mijin Yun  ;  Byoung Chul Cho  ;  Chang Geol Lee  ;  Ki Chang Keum 
 Cancer Research and Treatment, Vol.48(3) : 928-941, 2016 
Journal Title
 Cancer Research and Treatment 
Issue Date
Adolescent ; Adult ; Aged ; Carcinoma/diagnostic imaging* ; Carcinoma/mortality ; Carcinoma/pathology ; Carcinoma/therapy* ; Chemoradiotherapy ; Disease Progression ; Disease-Free Survival ; Female ; Fluorodeoxyglucose F18/administration & dosage ; Follow-Up Studies ; Glycolysis/radiation effects* ; Humans ; Induction Chemotherapy ; Male ; Middle Aged ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Nasopharyngeal Neoplasms/mortality ; Nasopharyngeal Neoplasms/pathology ; Nasopharyngeal Neoplasms/therapy* ; Neoplasm Staging ; Positron-Emission Tomography/methods ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Radiation Dosage* ; Radiopharmaceuticals/administration & dosage ; Radiotherapy, Conformal* ; Radiotherapy, Intensity-Modulated* ; Retrospective Studies ; Treatment Failure ; Tumor Burden ; Young Adult
18F-fluorodeoxyglucose ; Intensity-modulated radiotherapy ; Nasopharyngeal carcinoma ; Positron emission tomography ; Radiotherapy dosage
PURPOSE: We investigated (18)F-fluorodeoxyglucose positron emission tomography (PET)-derived parameters as prognostic indices for disease progression and survival in locally advanced nasopharyngeal carcinoma (NPC) and the effect of high-dose radiotherapy for a subpopulation with PET-based poor prognoses. MATERIALS AND METHODS: Ninety-seven stage III and Iva-b NPC patients who underwent definitive treatment and PET were reviewed. For each primary, nodal, and whole tumor, maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) were evaluated. RESULTS: Based on the C-index (0.666) and incremental area under the curve (0.669), the whole tumor TLGwas the most useful predictorfor progression-free survival (PFS); thewhole tumor TLG cut-off value showing the best predictive performance was 322.7. In multivariate analysis, whole tumor TLG was a significant prognostic factor for PFS (hazard ratio [HR], 0.3; 95% confidence interval [CI], 0.14 to 0.65; p=0.002) and OS (HR, 0.29; 95% CI, 0.11 to 0.79; p=0.02). Patients with low whole tumor TLG showed the higher 5-year PFS in the subgroup for only patients receiving intensity modulated radiotherapy (77.4% vs. 53.0%, p=0.01). In the subgroup of patients with high whole tumor TLG, patients receiving an EQD2 ≥ 70 Gy showed significantly greater complete remission rates (71.4% vs. 33.3%, p=0.03) and higher 5-year OS (74.7% vs. 19.6%, p=0.02). CONCLUSION: Our findings demonstrated that whole tumor TLG could be an independent prognostic factor and high-dose radiotherapy could improve outcomes for NPC showing high whole tumor TLG.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
금기창(Keum, Ki Chang) ORCID logo https://orcid.org/0000-0003-4123-7998
윤미진(Yun, Mi Jin) ORCID logo https://orcid.org/0000-0002-1712-163X
윤홍인(Yoon, Hong In) ORCID logo https://orcid.org/0000-0002-2106-6856
이정심(Lee, Jeong Shim)
이창걸(Lee, Chang Geol) ORCID logo https://orcid.org/0000-0002-8702-881X
조병철(Cho, Byoung Chul) ORCID logo https://orcid.org/0000-0002-5562-270X
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