title: Radiation response non-invasively imaged by [18F]FDG-PET predicts local tumor control and survival in advanced oral squamous cell carcinoma.
abstract: It is a major challenge to preoperatively identify patients who will profit from surgery of advanced oral cancer. In multimodality therapy, response to neoadjuvant radiation correlates to treatment success. Hence, for preoperative decisions, assessment of treatment response is required. Therefore, we analysed the prognostic significance of glucose metabolism after preoperative radiotherapy. [(18)F]FDG-PET investigations were performed for re-staging 35 patients after neoadjuvant radiotherapy (36Gy) immediately prior to tumor resection. Emission and transmission measurements were obtained and SUV's were calculated for the sites of maximum [(18)F]FDG-uptake. Subpopulations of "low" (SUV < 4) and "high" (SUV > or = 4) glucose metabolism were compared by univariate and multivariate survival analysis. 3-years survival was 80% in the "low" SUV group and 43% in the "high" SUV group. Post-irradiation [(18)F]FDG-uptake significantly predicts survival (P = 0.046) and local tumor control (P = 0.0017). High [(18)F]FDG-uptake was associated with an increased hazard of death (P = 0.037) and especially of local progress (P = 0.011) even when radical resection was performed. Thus, [(18)F]FDG-PET non invasively identified patients with poor prognosis whose indication for radical surgery has to be considered with caution.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Mainz, Augustusplatz 2, 55101 Mainz, Germany. kunkel@mkg.klinik.uni-mainz.de
authors.forename: Martin
authors.initials: M
authors.lastname: Kunkel
authors.forename: Gregor J
authors.initials: GJ
authors.lastname: Förster
authors.forename: Torsten E
authors.initials: TE
authors.lastname: Reichert
authors.forename: Joachim
authors.initials: J
authors.lastname: Kutzner
authors.forename: Peter
authors.initials: P
authors.lastname: Benz
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Wilfried
authors.initials: W
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D016017:Odds Ratio; D011379:Prognosis; D019275:Radiopharmaceuticals; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18