Predictive value of 1H MR spectroscopy and 18F-FDG PET/CT for local control of advanced oropharyngeal and hypopharyngeal squamous cell carcinoma receiving chemoradiotherapy: a prospective study
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Chih-Hua Yeh1,2,3,* Gigin Lin1,2,3,4,* Jiun-Jie Wang3,5, Chien-Yu Lin6, Shang-Yueh Tsai7, Yu-Chun Lin1,2,3, Yi-Ming Wu1,2,3, Sheung-Fat Ko3,8, Hung-Ming Wang9, Sheng-Chieh Chan2,10, Tzu-Chen Yen2,10, Chun-Ta Liao11 and Shu-Hang Ng1,2,3
1Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
2Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
3Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
4Clinical Phenome Center and Imaging Core Lab, Institute for Radiological Research, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
5Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan
6Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
7Graduate Institute of Applied Physics, National Chengchi University, Taipei, Taiwan
8Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
9Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
10Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
11Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
*These authors have contributed equally to this work
Shu-Hang Ng, email: firstname.lastname@example.org
Keywords: oropharyngeal cancer; hypopharyngeal cancer; MR spectroscopy; positron emission tomography; chemoradiotherapy
Received: June 17, 2017 Accepted: December 05, 2017 Published: December 14, 2017
Purpose: To determine whether pretreatment in vivo 1H magnetic resonance (MR) spectroscopy at 3 Tesla (T) and 18F-FDG PET/CT can offer predictive power regarding the local control of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients.
Materials and Methods: 1H MR spectroscopy was performed in addition to conventional MR imaging before definitive chemoradiotherapy in 58 patients with advanced OHSCC. The relationship of local control with the 1H MR spectroscopy and 18F-FDG PET/CT parameters was analyzed.
Results: With a median follow-up of 17.6 months, 13 (22.4%) patients exhibited local failure; whereas the remaining 45 achieved local control. Kaplan-Meier analysis identified age > 60 years, creatine level on MRS ≦ 6.02 mM, glutamine and glutamate (Glx) level on MRS > 3.31 mM, and total lesion glycolysis (TLG) on 18F-FDG PET/CT > 217.18 g/mL × mL as significant adverse predictors for 2-year local control. Multivariate Cox regression analysis showed that age (p=0.017), Glx level on MRS (p=0.021), and TLG on 18F-FDG PET/CT (p=0.028) retained their independent prognostic significance. A scoring system was constructed based on the sum of these three factors. We found that patients with scores of 2–3 had significantly poorer local control rates than patients with scores of 0–1 (33.3% versus 86.8%, p=0.003).
Conclusion: We conclude that Glx on 1H MR spectroscopy at 3 T was the independent prognostic factor for local control of OHSCC patients treated with chemoradiotherapy, and its combination with age and TLG may help identify a subgroup of patients at high risk for developing local failure.
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