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The Role of Pretreatment 18F-FDG PET/CT for Early Prediction of Neoadjuvant Chemotherapy Response in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

Authors
  • Yao, Jijin1, 2
  • Wang, Ying3
  • Lin, Yujing4
  • Yang, Yingying5
  • Wan, Jingjing3
  • Gong, Xiaohua1
  • Zhang, Fanwei3
  • Zhang, Wangjian6
  • Marks, Tia7
  • Wang, Siyang1
  • Jin, Hongjun2
  • Shan, Hong2, 8
  • 1 The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, 519000
  • 2 Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, 519000
  • 3 Department of Nuclear Medicine, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, 519000
  • 4 Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, 519001
  • 5 Department of Pharmacy, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, 519000
  • 6 Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080
  • 7 Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, 12144
  • 8 Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, 519000
Type
Published Article
Journal
Drug Design Development and Therapy
Publisher
Dove Medical Press
Publication Date
Oct 01, 2021
Volume
15
Pages
4157–4166
Identifiers
DOI: 10.2147/DDDT.S330154
PMCID: PMC8491868
Source
PubMed Central
Keywords
Disciplines
  • Original Research
License
Unknown

Abstract

Introduction To evaluate the role of maximal standardized uptake values (SUVmax) and total lesion glycolysis (TLG) from serial 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for early prediction of neoadjuvant chemotherapy (NAC) response in locoregionally advanced nasopharyngeal carcinoma (LANPC). Methods A total of 121 LANPC patients who completed pretreatment 18F-FDG PET/CT between June 2017 and July 2020 were retrospectively included. The median age of all the participants was 50 years old (range: 19–74 years), with 94 (77.7%) males and 27 (22.3%) females. The SUVmax from the primary tumor site (SUVmax-PT) and the total lesion glycolysis from the primary tumor site (TLG-PT) were recorded. Tumor response was calculated according to the Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 Criteria at two-week post-secondary NAC cycle. Patients who achieved an objectively partial or full reaction after two cycles of NAC were defined as ‘responders’, and patients who obtained stability or progression were classified as ‘non-responders’. Results After two cycles of NAC, 96 patients were categorized as “responders” and 25 patients as “non-responders”. The optimal thresholds of the SUVmax-PT were 11.8 and 38.5 for the TLG-PT. Non-responders were significantly associated with high SUVmax-PT (HR, 3.49; 95% CI, 1.17–10.36; p = 0.024) and TLG-PT (HR, 4.45; 95% CI, 1.44–13.78; p = 0.010) in multivariate analysis. Recursive partitioning analysis (RPA) categorized patients into three prognostic groups based on SUVmax-PT and TLG-PT: high-response group, intermediate-response group, and low-response group, with corresponding favorable response rates of 94%, 80%, and 55%, respectively. Moreover, a nomogram was created based on metabolic parameters that precisely projected an individual’s response of NAC (C-index, 0.787; 95% CI, 0.533–1.000). Conclusion Pretreatment 18F-FDG PET/CT to measure SUVmax-PT and TLG-PT could be a useful non-invasive method for early indication of NAC efficacy. The nomogram based on PET/CT parameters may potentially provide direction for treatment decisions based on NAC levels.

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