Use Of 18f-Fdg Pet/Ct Imaging For Radiotherapy Target Volume Delineation After Induction Chemotherapy And For Prognosis Of Locally Advanced Squamous Cell Carcinoma Of The Head And Neck

Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As F-18-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of F-18-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUVmax, MTV and TLG in primary tumor and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progress was localized in high-to-intermediate dose (60-70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUVmax >= 74% (p = 0.04), MTV >= 68% (p = 0.03), TLG >= 76% (p = 0.03) in primary tumor, and LN TLG decrease >= 74% (p = 0.03) were associated with PFS. Decrease of primary tumor SUVmax >= 74% (p = 0.04), MTV >= 69% (p = 0.03), TLG >= 74% (p = 0.02) and LN TLG >= 73% (p = 0.02) were prognostic factors for OS. Conclusions: According to our results, F-18-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impacts on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUVmax, MTV and TLG has a prognostic value in LA-SCCHN.