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Combined PET/CT-perfusion in patients with head and neck cancers might predict failure after radio-chemotherapy: a proof of concept study.

Pietsch C, de Galiza Barbosa F, Hüllner MW, Schmid DT, Haerle SK, Huber GF, Studer G, Hany TF, Veit-Haibach P - BMC Med Imaging (2015)

Bottom Line: Patients with recurrent disease had significantly higher initial CTP-values compared to the recurrence-free patients: BFpre 267.4 (171.2)ml/100 mg/min, BVpre 40.9 (8.4)ml/100 mg and MTTpre 8.2 (6.1)sec.No higher SUVs initially but significantly higher TLG compared to patients without recurrence were found.Post-therapeutic PET-values differed significantly between the two groups: SUVmaxpost 6.0 (3.2), SUVmeanpost 3.6 (2.0) and TLG 21751.7 (29794.0).

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zuerich, Switzerland. carsten.Pietsch@usz.ch.

ABSTRACT

Background: [18F]FDG-PET/CT imaging is broadly used in head and neck cancer (HNSCC) patients. CT perfusion (CTP) is known to provide information about angiogenesis and blood-flow characteristics in tumors. The aim of this study was to evaluate the potential relationship of FDG-parameters and CTP-parameters in HNSCC preand post-therapy and the potential prognostic value of a combined PET/CT with CTP.

Methods: Thirteen patients with histologic proven HNSCC were prospectively included. All patients underwent a combined PET/CT with integrated CTP before and after therapy. Pre- and post-therapeutic data of CTP and PET of the tumors were compared. Differences were tested using Spearman's rho test and Pearson's correlation. A p-value of p <0.05 was considered statistically significant. Correlations were calculated using Pearson's correlation. Bootstrap confidence intervals were calculated to test for additive confidence intervals.

Results: Three patients died due to malignancy recurrence, ten patients were free of recurrence until the end of the follow-up period. Patients with recurrent disease had significantly higher initial CTP-values compared to the recurrence-free patients: BFpre 267.4 (171.2)ml/100 mg/min, BVpre 40.9 (8.4)ml/100 mg and MTTpre 8.2 (6.1)sec. No higher SUVs initially but significantly higher TLG compared to patients without recurrence were found. Post-therapeutic PET-values differed significantly between the two groups: SUVmaxpost 6.0 (3.2), SUVmeanpost 3.6 (2.0) and TLG 21751.7 (29794.0).

Conclusion: In our proof of concept study, combined PET/CT with integrated CTP might show complementary prognostic data pre- and post chemo-radiotherapy. CTP may be used to predict local tumor recurrence, while FDGPET/CT is still needed for whole-body staging.

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71 yo male with squamous cell carcinoma of the larynx. CTP. 1a–c: axial Blood flow, Blood volume, Mean Transit Time. Pre-therapeutic scan showing the tumor (arrow). 2a-c axial Blood flow, Blood volume, Mean Transit Time. Post-therapeutic scan showing the residual reactive changes without tumor (arrow)
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Fig2: 71 yo male with squamous cell carcinoma of the larynx. CTP. 1a–c: axial Blood flow, Blood volume, Mean Transit Time. Pre-therapeutic scan showing the tumor (arrow). 2a-c axial Blood flow, Blood volume, Mean Transit Time. Post-therapeutic scan showing the residual reactive changes without tumor (arrow)

Mentions: First CTP-values and SUV-values, pre- versus postterapeutic including their change (Δ) were compared and all the mean values demonstrated in the Table 2 (see also Figs. 1 and 2). A comparison between the patients that died with recurrent disease and the recurrence free patients is shown in Table 3. Initial CTP-values were higher for the three patients that died during the follow up period but post-therapy CTP-values for those patients did not differ significantly from those without recurrence. Significant correlation was found between ΔBF and ΔBV (p <0.01).Table 2


Combined PET/CT-perfusion in patients with head and neck cancers might predict failure after radio-chemotherapy: a proof of concept study.

Pietsch C, de Galiza Barbosa F, Hüllner MW, Schmid DT, Haerle SK, Huber GF, Studer G, Hany TF, Veit-Haibach P - BMC Med Imaging (2015)

71 yo male with squamous cell carcinoma of the larynx. CTP. 1a–c: axial Blood flow, Blood volume, Mean Transit Time. Pre-therapeutic scan showing the tumor (arrow). 2a-c axial Blood flow, Blood volume, Mean Transit Time. Post-therapeutic scan showing the residual reactive changes without tumor (arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696250&req=5

Fig2: 71 yo male with squamous cell carcinoma of the larynx. CTP. 1a–c: axial Blood flow, Blood volume, Mean Transit Time. Pre-therapeutic scan showing the tumor (arrow). 2a-c axial Blood flow, Blood volume, Mean Transit Time. Post-therapeutic scan showing the residual reactive changes without tumor (arrow)
Mentions: First CTP-values and SUV-values, pre- versus postterapeutic including their change (Δ) were compared and all the mean values demonstrated in the Table 2 (see also Figs. 1 and 2). A comparison between the patients that died with recurrent disease and the recurrence free patients is shown in Table 3. Initial CTP-values were higher for the three patients that died during the follow up period but post-therapy CTP-values for those patients did not differ significantly from those without recurrence. Significant correlation was found between ΔBF and ΔBV (p <0.01).Table 2

Bottom Line: Patients with recurrent disease had significantly higher initial CTP-values compared to the recurrence-free patients: BFpre 267.4 (171.2)ml/100 mg/min, BVpre 40.9 (8.4)ml/100 mg and MTTpre 8.2 (6.1)sec.No higher SUVs initially but significantly higher TLG compared to patients without recurrence were found.Post-therapeutic PET-values differed significantly between the two groups: SUVmaxpost 6.0 (3.2), SUVmeanpost 3.6 (2.0) and TLG 21751.7 (29794.0).

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zuerich, Switzerland. carsten.Pietsch@usz.ch.

ABSTRACT

Background: [18F]FDG-PET/CT imaging is broadly used in head and neck cancer (HNSCC) patients. CT perfusion (CTP) is known to provide information about angiogenesis and blood-flow characteristics in tumors. The aim of this study was to evaluate the potential relationship of FDG-parameters and CTP-parameters in HNSCC preand post-therapy and the potential prognostic value of a combined PET/CT with CTP.

Methods: Thirteen patients with histologic proven HNSCC were prospectively included. All patients underwent a combined PET/CT with integrated CTP before and after therapy. Pre- and post-therapeutic data of CTP and PET of the tumors were compared. Differences were tested using Spearman's rho test and Pearson's correlation. A p-value of p <0.05 was considered statistically significant. Correlations were calculated using Pearson's correlation. Bootstrap confidence intervals were calculated to test for additive confidence intervals.

Results: Three patients died due to malignancy recurrence, ten patients were free of recurrence until the end of the follow-up period. Patients with recurrent disease had significantly higher initial CTP-values compared to the recurrence-free patients: BFpre 267.4 (171.2)ml/100 mg/min, BVpre 40.9 (8.4)ml/100 mg and MTTpre 8.2 (6.1)sec. No higher SUVs initially but significantly higher TLG compared to patients without recurrence were found. Post-therapeutic PET-values differed significantly between the two groups: SUVmaxpost 6.0 (3.2), SUVmeanpost 3.6 (2.0) and TLG 21751.7 (29794.0).

Conclusion: In our proof of concept study, combined PET/CT with integrated CTP might show complementary prognostic data pre- and post chemo-radiotherapy. CTP may be used to predict local tumor recurrence, while FDGPET/CT is still needed for whole-body staging.

Show MeSH
Related in: MedlinePlus