Role of pretreatment 18F-FDG PET/CT parameters in predicting outcome of non-endemic EBV DNA-related nasopharyngeal cancer (NPC) patients treated with IMRT and chemotherapy.

Abstract

PURPOSE:

To evaluate the prognostic role of pretreatment 18F-FDG PET/CT metabolic parameters in non-endemic Epstein-Barr Virus (EBV DNA)-related nasopharyngeal cancer (NPC) patients treated with curative intensity-modulated radiation therapy (IMRT) with or without chemotherapy (CHT).

MATERIALS/METHODS:

We retrospectively reviewed clinical data of 160 consecutive non-metastatic NPC patients who received IMRT with or without CHT. Forty-nine out of 160 patients that underwent whole body 18F-FDG PET/CT at our institution for disease staging with a minimum follow-up to 12 months were included in this study. We evaluated the relationship between maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), metabolic tumor volume and total lesion glycolysis (TLG) of primary tumor and cervical lymph nodes with disease-free survival (DFS) and overall survival (OS). We also investigated the prognostic role of clinical variables such as age, disease stage, plasma EBV DNA load (copies/ml), gross tumor volume of primary tumor and lymph nodes.

RESULTS:

Median follow-up was 55 months. Two- and 5-year OS were 95.8% and 90.5%, respectively, while DFS was 83.4% at both time points. SUVmax of primary tumor ≥ 18.8 g/ml and primary tumor TLG ≥ 203.1 g were significant prognostic factors of worse OS. Furthermore, stages IVB and EBV DNA load ≥ 3493 copies/ml were significantly associated with lower DFS. No correlation was found between PET parameters and plasma EBV DNA load.

CONCLUSION:

Even in a limited series, our data suggested that SUVmax, SUVmean and TLG of primary tumor could predict a poor outcome in NPC patients also in non-endemic area hypothesizing their use for refinement of prognostication.

• Authors: Alessandra Alessi, Alice Lorenzoni, Anna Cavallo, Barbara Padovano, Nicola Alessandro Iacovelli, Paolo Bossi, Salvatore Alfieri, Gianluca Serafini, Carlotta Benedetta Colombo, Alessandro Cicchetti, Marta Mira, Lisa Licitra, Carlo Fallai, Flavio Crippa, Ester Orlandi
• Journal: La Radiologia medica (Radiol Med) Vol. 124 Issue 5 Pg. 414-421 (May 2019) ISSN: 1826-6983 [Electronic] Italy
• PMID: 30560502 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• DNA, Viral
• Radiopharmaceuticals
• Fluorodeoxyglucose F18

Topics

• Adult
• Aged
• Aged, 80 and over
• Biomarkers, Tumor (blood)
• Combined Modality Therapy
• DNA, Viral (blood)
• Female
• Fluorodeoxyglucose F18
• Herpesvirus 4, Human
• Humans
• Male
• Middle Aged
• Nasopharyngeal Neoplasms (diagnostic imaging, drug therapy, radiotherapy, virology)
• Neoplasm Staging
• Positron Emission Tomography Computed Tomography
• Prognosis
• Radiographic Image Interpretation, Computer-Assisted
• Radiopharmaceuticals
• Radiotherapy, Intensity-Modulated
• Retrospective Studies
• Survival Rate
• Treatment Outcome
• Viral Load
• Whole Body Imaging