Table 5.
Studies evaluating prognostic value of pre-treatment positron emission tomography volumetric parameters
| Author | n | Year | Study design | Tumour location | Treatment | Summary results |
|---|---|---|---|---|---|---|
| La et al110 | 85 | 2009 | Retrospective | Oropharynx Hypopharynx Larynx Oral cavity CUP |
CCRT | An increase in MTV of 17.4 m was associated with an increased hazard of first event (recurrence or death) (1.9-fold, p < 0.001), and of death (2.1-fold, p < 0.001). SUVmax was not associated with DFS or OS |
| Chung et al114 | 82 | 2009 | Retrospective | Nasopharynx Oropharynx Hypopharynx |
Cisplatin-based CCRT | MTV >40 ml indicated a significantly worse DFS than MTV ≤40 ml (HR, 3.42; 95% CI, 1.04–11.26; p = 0.04). SUV did not show any prognostic impact on DFS |
| Kim et al115 | 69 | 2011 | Retrospective | Oropharynx Hypopharynx Larynx Oral cavity |
Surgery + RT (±CC) | Patients with MTV >41 ml showed short DFS and 2.4-fold higher recurrence or death than patients with MTV ≤41 (p = 0.041) |
| Park et al116 | 81 | 2013 | Retrospective | Hypopharynx Larynx |
Surgery + RT(±CC)/cisplatin-based CCRTa | MTV was an independent prognostic factor for both LRC (p = 0.018; HR = 3.141, 95% CI = 1.175–8.399) and OS (p = 0.008; HR = 3.758, 95% CI = 1.415–9.982) |
| Kao et al117 | 64 | 2012 | Retrospective | Oropharynx Hypopharynx |
CCRT | Patients with MTV2.5 > 13.6 ml had a significantly inferior 2-year PRFS compared with patients who had lower MTV2.5 tumours (39 vs 72%, respectively, p = 0.001) |
| Dibble et al118 | 45 | 2012 | Retrospective | Oropharynx Oral cavity |
Surgery + RT/CCRT | Primary tumour MTV (median cut-off point of 7.7 ml) was predictive of OS (p = 0.04). Primary tumour TGA (median cut-off point of 55 g) was predictive of OS (log rank p = 0.08) |
| Lim et al119 | 176 | 2012 | Retrospective | Oropharynx | CCRT/surgery | SUVmax was not associated with OS after adjusting for T stage (p = 0.158). In multivariate analysis, TLG and MTV remained associated with OS after correcting for T stage (p = 0.0125 and 0.0324, respectively) and HRs of 1.45 and 1.43, respectively |
| Lee et al120 | 57 | 2012 | Retrospective | Oropharynx | Surgery/surgery + adjuvant therapy | On a univariate analysis, SUVmax, SUVavg, MTV and TLG of primary tumour were significant predictors of survival. However, on multivariate analysis, only patients with high MTV (≥7.78 cm3) showed significantly worse prognoses (p = 0.037) |
| Tang et al121 | 83 | 2012 | Retrospective | Oropharynx Nasopharynx Hypopharynx Larynx Oral cavity CUP |
RT/CCRT | An increase in total MTV of 17 cm3 was associated with a 2.1-fold increase in the risk of disease progression (p = 0.0002) and a 2.0-fold increase in the risk of death (p = 0.0048). SUVmax was not associated with either outcome |
| Moon et al122 | 83 | 2013 | Retrospective | Tonsil | RT alone Surgery alone CCRT Surgery CCRT or RT |
On multivariate analyses, only TLG (HR = 1.020, 95% CI = 1.003–1.037, p = 0.023) was an independent predictive factor associated with decreased OS. MTV and SUVmax were not associated with outcomes |
| Abd El-Hafez et al123 | 126 | 2013 | Prospective | Oropharynx | Surgery/CCRT | TLG and SUVmax were independent prognostic factors for 2-year DSS. Patients with high (T)TLG (≥71.4) had a 2-year DFS of 52%, whereas 74% for those with a low (T)TLG (p = 0.007); the 2-year-DSS rates were 53% vs 84%, respectively (p < 0.001). Patients with high (N)SUVmax (≥7.5) had a 2-year DFS of 42% vs 70% for patients with a low (N)SUVmax (p = 0.001); the 2-year-DSS rates were 39% vs 78%, respectively (p < 0.001) |
| Garsa et al124 | 86 | 2013 | Retrospective | Oropharynx | CCRT | On multivariate analysis, a total MTV >20.5 ml was associated with a 13.0-fold increased risk of death (95% CI = 1.62–100; p = 0.016) for the p16-positive subgroup compared with a 4.27-fold increased risk of death (95% CI = 1.28–14.3; p = 0.018) for the p16-negative subgroup. SUVmax, SUVmean failed to predict DFS or OS |
| Romesser et al125 | 100 | 2014 | Retrospective | Oropharynx | CCRT | On multivariate analysis, a larger MTV (<9.7 cm3) retained a significant correlation with an increased risk for distant metastasis (HR = 2.47; 95% CI = 1.46–4.17; p = 0.001), disease progression or death (HR = 2.17; 95% CI = 1.40–3.38; p = 0.001), and death (HR = 2.37; 95% CI = 1.44–3.89; p = 0.001). SUVmax failed to correlate with any outcome |
| Hanamoto et al126 | 118 | 2014 | Retrospective | Nasopharynx Oropharynx Laryngohypopharyngeal |
CCRT | After multivariate analysis, high MTV (>25.0 ml) and high TLG (>144.8 g) remained as independent, significant predictors of incomplete response compared with low MTV (OR = 13.4; 95% CI = 2.5–72.9; p = 0.003) and low TLG (OR = 12.8; 95% CI = 2.4–67.9; p = 0.003), respectively |
| Alluri et al127 | 70 | 2014 | Retrospective | Oropharynx (HPV positive) | RT alone/CCRT CCRT + surgery Surgery + CCRT |
Total MTV and primary tumour MTV remained as independent prognostic markers for EFS. There was no statistically significant association of EFS with SUVmax, SUVmean and primary tumour or overall TLG |
| Picchio et al112 | 19 | 2014 | Retrospective | Oropharynx Nasopharynx Larynx |
RT/CCRT | MTV (≥32.4 cm3) and TLG (≥469.8 g) predicted patients' outcome with respect to all the considered local and distant disease control end points (LRFS, DMFS and DFS). SUVmean cut-off value predictive of LRFS and DFS were 10.8 |
| Schwartz et al128 | 74 | 2015 | Population subanalysis of Phase III trial (RTOG 0522) | Oropharynx Larynx Hypopharynx |
CCRT (cisplatin and cetuximab) | Primary tumour MTV was a strong independent prognostic factor for PFS. SUVmax was not associated with poor treatment outcomes |
| Yabuki et al129 | 118 | 2015 | Retrospective | Larynx | RT or CCRT | On multivariate analysis, the 3-year DFS for patients with a high MTV were significantly poorer than those with a low MTV (p < 0.001) |
CC, concurrent chemotherapy; CCRT, concurrent chemoradiotherapy; CI, confidence interval; CUP, carcinoma with unknown primary; DFS, disease-free survival; DMFS, distant metastasis-free survival; DSS, disease-specific survival; EFS, event free survival (either recurrence of disease at the primary site, at regional nodes, or at distant metastatic sites or overall patient mortality); HPV, human papillomavirus; HR, hazard ratio; LRC, locoregional control; LRFS, local recurrence-free survival; MTV, metabolic tumour volume; MTV2.5, PET segmentation used applying on isocontour at a SUV of 2.5; n, number of patients; (N)SUVmax, nodal SUVmax; OR, odds ratio; OS, overall survival; PFS: progression-free survival; PRFS, primary relapse-free survival; RT, radiotherapy; RTOG, Radiation Therapy Oncology Group; SUV, standardized uptake value; SUVavg, average SUV; SUVmax, maximal SUV; SUVmean, mean SUV; TGA, total glycolytic activity; TLG, total lesion glycolysis; (T)TLG, tumour total lesion glycolysis.
a
Several patients received induction chemotherapy.