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Preoperative [18F]-fluorodeoxyglucose positron emission tomography standardized uptake value of neck lymph nodes may aid in selecting patients with oral cavity squamous cell carcinoma for salvage therapy after relapse

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Abstract

Purpose

Relapse of tumours in patients with oral cavity squamous cell carcinoma (OSCC) is associated with a dismal outcome. In this prospective study, we sought to investigate the clinical significance of the preoperative maximal standardized uptake value (SUVmax) at the neck lymph nodes in selecting patients with OSCC for salvage therapy after relapse.

Methods

Between 2002 and 2007, 108 patients with early relapse of OSCC (n=75) or late relapse of OSCC (n=33) were identified. Salvage therapy was performed in 47 patients. All patients underwent 2-deoxy-2[18F]-fluoro-d-glucose positron emission tomography during the 2 weeks before surgery and neck dissection. All patients were followed for 12 months or more after surgery or until death. The optimal cut-off value for the neck lymph node SUVmax (SUVnodal-max) was selected according to the 5-year disease-specific survival (DSS) rate. Independent risk factors were identified by Cox regression analysis.

Results

The mean follow-up for all patients was 20.3 months (41.1 months for surviving patients). In the early relapse group, several prognostic factors were identified in univariate and multivariate analyses, including a SUVnodal-max value of ≥4.2. A scoring system based on univariate analysis was formulated. Patients with a score of 0 had a better 5-year DSS than those with scores of 1 or higher (58% vs. 5%, p=0.0003). In patients with late relapse, a SUVnodal-max value of ≥4.2 had the highest prognostic value for predicting the 5-year DSS (45% vs. 0%, p=0.0005).

Conclusion

Among patients with relapsed OSCC, the SUVnodal-max value may aid in selecting patients for salvage therapy.

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References

  1. Liao CT, Chang JT, Wang HM, et al. Salvage therapy in relapsed squamous cell carcinoma of the oral cavity: How and when? Cancer 2008;12:94–103. doi:10.1002/cncr.23142.

    Article  Google Scholar 

  2. Liao CT, Chang JT, Wang HM, et al. Preoperative [18]F-FDG PET standardized uptake value of neck lymph nodes predicts neck control and survival rates in patients with oral cavity squamous cell carcinoma and pathologically positive lymph nodes. Int J Radiat Oncol Biol Phys 2009; in press.

  3. Fleming ID, Cooper JS, Henson DE, et al. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven; 1997.

    Google Scholar 

  4. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag; 2002.

    Google Scholar 

  5. Liao CT, Chang JT, Wang HM, et al. Surgical outcome of T4a and resected T4b oral cavity cancer. Cancer 2006;107:337–44. doi:10.1002/cncr.21984.

    Article  PubMed  Google Scholar 

  6. Liao CT, Ng SH, Chang JT, et al. T4b oral cavity cancer below the mandibular notch is resectable with a favorable outcome. Oral Oncol 2007;43:570–9. doi:10.1016/j.oraloncology.2006.06.008.

    Article  PubMed  Google Scholar 

  7. Liao CT, Chang JT, Wang HM, et al. Pretreatment primary tumor SUVmax measured by FDG-PET and pathological tumor depth predict poor outcomes in patients with oral cavity squamous cell carcinoma and pathologically positive lymph nodes. Int J Radiat Oncol Biol Phys 2008;73:764–71. doi:10.1016/j.ijrobp. 2008.05.004.

    PubMed  Google Scholar 

  8. Yen TC, Ng KK, Ma SY, et al. Value of dual-phase 2-fluoro-2-deoxy-d-glucose positron emission tomography in cervical cancer. J Clin Oncol 2003;21:3651–8. doi:10.1200/JCO.2003.01.102.

    Article  PubMed  Google Scholar 

  9. Bachaud JM, Cohen-Jonathan E, Alzieu C, David JM, Serrano E, Daly-Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys 1996;36:999–1004. doi:10.1016/S0360-3016(96)00430-0.

    PubMed  CAS  Google Scholar 

  10. Wang HM, Wang CS, Chen JS, et al. Cisplatin, tegafur, and leucovorin: a moderately effective and minimally toxic outpatient neoadjuvant chemotherapy for locally advanced squamous cell carcinoma of the head and neck. Cancer 2002;94:2989–95. doi:10.1002/cncr.10570.

    Article  PubMed  CAS  Google Scholar 

  11. Liao CT, Chang JT, Wang HM, et al. Analysis of risk factors predictive of local tumor control in oral cavity cancer. Ann Surg Oncol 2008;15:915–22. doi:10.1245/s10434-007-9761-5.

    Article  PubMed  Google Scholar 

  12. Allal AS, Slosman DO, Kebdani T, Allaoua M, Lehmann W, Dulguerov P. Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18F]fluoro-2-deoxy-D-glucose. Int J Radiat Oncol Biol Phys 2004;59:1295–300. doi:10.1016/j.ijrobp. 2003.12.039.

    PubMed  CAS  Google Scholar 

  13. Halfpenny W, Hain SF, Biassoni L, Maisey MN, Sherman JA, McGurk M. FDG-PET. A possible prognostic factor in head and neck cancer. Br J Cancer 2002;86:512–6. doi:10.1038/sj.bjc.6600114.

    Article  PubMed  CAS  Google Scholar 

  14. Suzuki H, Hasegawa Y, Terada A, et al. FDG-PET predicts survival and distant metastasis in oral squamous cell carcinoma. Oral Oncol 2009; in press.

  15. Ng SH, Yen TC, Chang JT, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 2006;24:4371–6. doi:10.1200/JCO.2006.05.7349.

    Article  PubMed  Google Scholar 

  16. Wensing BM, Vogel WV, Marres HA, et al. FDG-PET in the clinically negative neck in oral squamous cell carcinoma. Laryngoscope 2006;116:809–13. doi:10.1097/01.mlg.0000209151.78362.d0.

    Article  PubMed  Google Scholar 

  17. Schoder H, Carlson DL, Kraus DH, et al. 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med 2006;47:755–62.

    PubMed  Google Scholar 

  18. Ng SH, Yen TC, Liao CT, et al. 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 2005;46:1136–43.

    PubMed  Google Scholar 

  19. Yen TC, Chang JT, Ng SH, et al. Staging of untreated squamous cell carcinoma of buccal mucosa with 18F-FDG PET: comparison with head and neck CT/MRI and histopathology. J Nucl Med 2005;46:775–81.

    PubMed  Google Scholar 

  20. Stoeckli SJ, Steinert H, Pfaltz M, Schmid S. Is there a role for positron emission tomography with 18F-fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma. Head Neck 2002;24:345–9. doi:10.1002/hed.10057.

    Article  PubMed  Google Scholar 

  21. Nakasone Y, Inoue T, Oriuchi N, et al. The role of whole-body FDG-PET in preoperative assessment of tumor staging in oral cancers. Ann Nucl Med 2001;15:505–12. doi:10.1007/BF02988503.

    Article  PubMed  CAS  Google Scholar 

  22. Stuckensen T, Kovacs AF, Adams S, Baum RP. Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 2000;28:319–24. doi:10.1054/jcms.2000.0172.

    PubMed  CAS  Google Scholar 

  23. Myers LL, Wax MK. Positron emission tomography in the evaluation of the negative neck in patients with oral cavity cancer. J Otolaryngol 1998;27:342–7.

    PubMed  CAS  Google Scholar 

  24. Braams JW, Pruim J, Nikkels PG, Roodenburg JL, Vaalburg W, Vermey A. Nodal spread of squamous cell carcinoma of the oral cavity detected with PET-tyrosine, MRI and CT. J Nucl Med 1996;37:897–901.

    PubMed  CAS  Google Scholar 

  25. Kovacs AF, Dobert N, Gaa J, Menzel C, Bitter K. Positron emission tomography in combination with sentinel node biopsy reduces the rate of elective neck dissections in the treatment of oral and oropharyngeal cancer. J Clin Oncol 2004;22:3973–80. doi:10.1200/JCO.2004.01.124.

    Article  PubMed  Google Scholar 

  26. Kunkel M, Helisch A, Reichert TE, et al. Clinical and prognostic value of [(18) F]FDG-PET for surveillance of oral squamous cell carcinoma after surgical salvage therapy. Oral Oncol 2006;42:297–305. doi:10.1016/j.oraloncology.2005.08.004.

    Article  PubMed  Google Scholar 

  27. Kunkel M, Forster GJ, Reichert TE, et al. Detection of recurrent oral squamous cell carcinoma by [18F]-2-fluorodeoxyglucose-positron emission tomography: implications for prognosis and patient management. Cancer 2003;98:2257–65. doi:10.1002/cncr.11763.

    Article  PubMed  Google Scholar 

  28. Kunkel M, Forster GJ, Reichert TE, et al. Radiation response non-invasively imaged by [18F]FDG-PET predicts local tumor control and survival in advanced oral squamous cell carcinoma. Oral Oncol 2003;39:170–7. doi:10.1016/S1368-8375(02)00087-8.

    Article  PubMed  Google Scholar 

  29. Wong RJ, Lin DT, Schoder H, et al. Diagnostic and prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol 2002;20:4199–208. doi:10.1200/JCO.2002.02.590.

    Article  PubMed  CAS  Google Scholar 

  30. McCollum AD, Burrell SC, Haddad RI, et al. Positron emission tomography with 18F-fluorodeoxyglucose to predict pathologic response after induction chemotherapy and definitive chemoradiotherapy in head and neck cancer. Head Neck 2004;26:890–6. doi:10.1002/hed.20080.

    Article  PubMed  Google Scholar 

  31. Yao M, Graham MM, Hoffman HT, et al. The role of post-radiation therapy FDG PET in prediction of necessity for post-radiation therapy neck dissection in locally advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2004;59:1001–10. doi:10.1016/j.ijrobp. 2004.01.040.

    Article  PubMed  Google Scholar 

  32. Lowe VJ, Dunphy FR, Varvares M, et al. Evaluation of chemotherapy response in patients with advanced head and neck cancer using [F-18]fluorodeoxyglucose positron emission tomography. Head Neck 1997;19:666–74. doi:10.1002/(SICI)1097-0347(199712)19:8<666::AID-HED4>3.0.CO;2-3.

    Article  PubMed  CAS  Google Scholar 

  33. Allal AS, Dulguerov P, Allaoua M, et al. Standardized uptake value of 2-[(18)F]fluoro-2-deoxy-D-glucose in predicting outcome in head and neck carcinomas treated by radiotherapy with or without chemotherapy. J Clin Oncol 2002;20:1398–404. doi:10.1200/JCO.20.5.1398.

    Article  PubMed  CAS  Google Scholar 

  34. Minn H, Lapela M, Klemi PJ, et al. Prediction of survival with fluorine-18-fluoro-deoxyglucose and PET in head and neck cancer. J Nucl Med 1997;38:1907–11.

    PubMed  CAS  Google Scholar 

  35. Schwartz DL, Rajendran J, Yueh B, et al. FDG-PET prediction of head and neck squamous cell cancer outcomes. Arch Otolaryngol Head Neck Surg 2004;130:1361–7. doi:10.1001/archotol.130.12.1361.

    Article  PubMed  Google Scholar 

  36. Kim SY, Roh JL, Kim MR, et al. Use of 18F-FDG PET for primary treatment strategy in patients with squamous cell carcinoma of the oropharynx. J Nucl Med 2007;48:752–7. doi:10.2967/jnumed.107.039610.

    Article  PubMed  Google Scholar 

  37. Bernier J, Domenge C, Ozsahin M, et al. European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350:1945–52. doi:10.1056/NEJMoa032641.

    Article  PubMed  CAS  Google Scholar 

  38. Cooper JS, Pajak TF, Forastiere AA, et al. Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350:1937–44. doi:10.1056/NEJMoa032646.

    Article  PubMed  Google Scholar 

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Acknowledgment

This study was supported by grants NMRPG160031 and CMRPG370061 from the Chang Gung Memorial Hospital at Linko.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Chun-Ta Liao, Shiang-Fu Huang & I-How Chen

  2. Department of Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Chun-Ta Liao, Shiang-Fu Huang & I-How Chen

  3. Head and Neck Oncology Group, Cancer Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Chun-Ta Liao, Joseph Tung-Chieh Chang, Hung-Ming Wang, Shu-Hang Ng, Shiang-Fu Huang, I-How Chen, Chuen Hsueh, Li-Yu Lee, Chih-Hung Lin, Ann-Joy Cheng & Tzu-Chen Yen

  4. Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Joseph Tung-Chieh Chang

  5. Hema-Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Hung-Ming Wang

  6. Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Shu-Hang Ng

  7. Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Chuen Hsueh & Li-Yu Lee

  8. Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Chih-Hung Lin

  9. Medical Biotechnology, Biostatistics Consulting Center/Department of Public Health, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Ann-Joy Cheng

  10. Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (R.O.C.)

    Tzu-Chen Yen

  11. Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linko, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan (R.O.C.)

    Tzu-Chen Yen

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  1. Chun-Ta Liao
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  2. Joseph Tung-Chieh Chang
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  4. Shu-Hang Ng
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  7. Chuen Hsueh
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  8. Li-Yu Lee
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  9. Chih-Hung Lin
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  11. Tzu-Chen Yen
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Corresponding author

Correspondence to Tzu-Chen Yen.

Additional information

Chun-Ta Liao and Hung-Ming Wang contributed equally to this work.

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Liao, CT., Chang, J.TC., Wang, HM. et al. Preoperative [18F]-fluorodeoxyglucose positron emission tomography standardized uptake value of neck lymph nodes may aid in selecting patients with oral cavity squamous cell carcinoma for salvage therapy after relapse. Eur J Nucl Med Mol Imaging 36, 1783–1793 (2009). https://doi.org/10.1007/s00259-009-1180-3

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  • DOI: https://doi.org/10.1007/s00259-009-1180-3

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