Value of pretreatment 18F-FLT PET/CT and 18F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma

doi:10.19401/j.cnki.1007-3639.2022.04.003

Abstract

Abstract:

Background and purpose: Nasopharyngeal carcinoma is one of the most common head and neck malignancies in Southeast Asia. Radiotherapy combined with chemotherapy is the main treatment for patients with locally advanced nasopharyngeal carcinoma (LANPC), however, different patients have various levels of clinical benefit. Therefore, early and accurate evaluation of the prognosis of LANPC after radiotherapy and chemotherapy is of great significance for clinical treatment decision-making. This paper aimed to evaluate and compare the value of ¹⁸F-Fluorothymidine (FLT) and ¹⁸F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging parameters in predicting the prognosis of patients with LANPC after radiotherapy and chemotherapy. Methods: Patients with LANPC who all received intensity-modulated radiation therapy (IMRT) and neoadjuvant chemotherapy (NACT) in Fudan University Shanghai Cancer Center from May 2012 to January 2015 were retrospectively selected. Clinical follow-up endpoint was progression-free survival (PFS), defined as the time from the beginning of treatment to tumor progression or death from any cause. The focus evaluation was based on the Response Evaluation Criteria in Solid Tumor 1.1 (RECIST 1.1). Pretreatment ¹⁸F-FLT and ¹⁸F-FDG PET/CT imaging were performed respectively. And the time interval between the two imaging was maintained within 1 week. The main parameters were measured, including maximal standardized uptake value (SUV_max), mean standardized uptake value (SUVmean), proliferative tumor volume (PTV)/metabolic tumor volume (MTV), total lesion thymidine (TLT)/ total lesion glucose (TLG) and tumor heterogeneity index (HI). Spearman rank correlation coefficient was used to analyze the correlation between the above PET/CT parameters and patients with metastasis/recurrence of LANPC. Then, the best cut-off value was determined by the receiver operating characteristic (ROC) curve, and the predictive ability was evaluated by the ROC curve. PFS was evaluated by the Kaplan-Meier method and log-rank test. Results: Among the 24 patients, 6 had metastasis or recurrence. The median follow-up time was 74.51 months. Spearman rank correlation coefficient analysis showed that HI_{(T-FLT-70%SUVmax)} was associated with metastasis or recurrence (P=0.04); ROC curve analysis showed that the sensitivity of HI_{(T-FLT-70%SUVmax)} in predicting metastatic or recurrent nasopharyngeal carcinoma was 80.00%, and the specificity was 79.90% (P=0.043). Survival analysis showed that when HI_{(T-FLT-70%SUVmax)}>0.828, the median PFS was 57.99 months, which was significantly shorter compared with patients with HI_{(T-FLT-70%SUVmax)}0≤0.828 (P=0.014). Conclusion: HI based on ¹⁸F-FLT PET/CT may be useful for predicting the prognosis of patients with LANPC receiving radiotherapy and chemotherapy.

Key words: PET/CT, Locally advanced nasopharyngeal carcinoma, Predicting, Prognosis

CLC Number:

R739.6

MA Guang, OU Xiaomin, HU Chaosu, SONG Shaoli, YANG Zhongyi. Value of pretreatment ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma[J]. China Oncology, 2022, 32(4): 309-315.

Figures/Tables 3

Tab. 1

Fig. 1

Tab. 2

References 20

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Threshold	FLT			Threshold	FDG
Threshold	Parameters	r value	P value	Threshold	Parameters	r value	P value
1.5	SUV_max-T	-0.096	0.654	2.5	SUV_max-T	-0.215	0.313
	PTV_-T	-0.067	0.757		MTV_-T	-0.245	0.249
	TLT_-T	-0.082	0.705		TLG_-T	-0.111	0.605
	HI_-T	0.111	0.605		HI_-T	0.289	0.171
	SUV_max-N	-0.14	0.544		SUV_max-N	0.150	0.516
	PTV_-N	0.108	0.649		MTV_-N	0.022	0.928
	TLT_-N	0.022	0.928		TLG_-N	0.108	0.649
	HI_-N	-0.043	0.856		HI_-N	-0.650	0.785
40%	PTV_-T	-0.067	0.757	40%	MTV_-T	-0.052	0.810
	TLT_-T	-0.052	0.810		TLG_-T	-0.082	0.705
	HI_-T	0.141	0.512		HI_-T	0.363	0.081
	PTV_-N	-0.080	0.730		MTV_-N	-0.020	0.931
	TLT_-N	-0.120	0.604		TLG_-N	0.100	0.666
	HI_-N	-0.180	0.434		HI_-N	0.240	0.294
50%	PTV_-T	-0.007	0.973	50%	MTV_-T	0.007	0.973
	TLT_-T	-0.052	0.810		TLG_-T	-0.067	0.757
	HI_-T	0.111	0.605		HI_-T	0.304	0.149
	PTV_-N	-0.100	0.666		MTV_-N	0.080	0.730
	TLT_-N	-0.140	0.544		TLG_-N	0.120	0.604
	HI_-N	-0.180	0.434		HI_-N	0.040	0.863
60%	PTV_-T	0.111	0.605	60%	MTV_-T	0.067	0.757
	TLT_-T	-0.007	0.973		TLG_-T	-0.052	0.810
	HI_-T	0.333	0.111		HI_-T	0.274	0.195
	PTV_-N	0.000	1.000		MTV_-N	0.160	0.488
	TLT_-N	-0.100	0.666		TLG_-N	0.140	0.544
	HI_-N	-0.320	0.157		HI_-N	-0.180	0.434
70%	PTV_-T	0.037	0.864	70%	MTV_-T	0.160	0.488
	TLT_-T	-0.022	0.918		TLG_-T	0.140	0.544
	HI_-T	0.423	0.040		HI_-T	-0.180	0.434
	PTV_-N	-0.060	0.796		MTV_-N	0.140	0.544
	TLT_-N	-0.100	0.666		TLG_-N	0.160	0.488
	HI_-N	0.140	0.544		HI_-N	-0.100	0.666

Factors	Number	PFS t/month	χ²	P value
Gender			0.794	0.373
Male	21	NR
Female	3	NR
Age/year			0.330	0.566
≤45	12	NR
>45	12	NR
AJCC staging			0.007	0.936
Ⅲ	14	NR
ⅣA	10	NR
HI_{(T-FLT-70%SUVmax)}			6.036	0.014
>0.828	8	57.99
≤0.828	16	NR

Value of pretreatment ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT uptake heterogeneity for early prediction of treatment outcome in locally advanced nasopharyngeal carcinoma

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