Early restaging whole-body (18)F-FDG PET during induction chemotherapy predicts clinical outcome in patients with locoregionally advanced nasopharyngeal carcinoma.
OBJECTIVE
This study was undertaken to evaluate the utility of whole-body (18)F-FDG PET in monitoring therapeutic effect during induction chemotherapy (IC) and in predicting prognosis in patients with locoregionally advanced nasopharyngeal carcinoma (NPC).


METHODS
Fifty patients who had histologically proven, locoregionally advanced NPC without distant metastasis and had received IC were recruited in this study. The study cohort consisted of 19 females and 31 males (age 17-72 years, mean 45.9+/-11.9). Whole-body (18)F-FDG PET was performed in each patient after completion of one (33 patients) or two (17 patients) courses of IC. Each patient was restaged on the basis of the (18)F-FDG PET results. Patients who were downstaged to stage I or II were classified as major responders; the rest were classified as non-major responders.


RESULTS
Only 1 of the 23 major responders subsequently developed local recurrence. At the time of data analysis, all major responders were alive; by contrast, of the 27 non-major responders, 15 had locoregional recurrence or distant metastasis and nine had died (seven of NPC and two of treatment-related complications). Kaplan-Meier survival analysis showed significantly longer recurrence-free survival and overall survival in major responders (56.4+/-9.2 and 58.1+/-2.2 months) as compared with non-major responders (33.7+/-23.2 and 44.7+/-20.0 months), with p<0.0001 and p=0.0024, respectively.


CONCLUSIONS
The results of this study suggest that early restaging by a single whole-body (18)F-FDG PET scan after the first or second course of IC is useful for predicting therapeutic response and outcome in patients with locoregionally advanced NPC.
Yen
Ruoh-Fang
RF
Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Chen
Tony Hsiu-Hsi
TH
Ting
Lai-Lei
LL
Tzen
Kai-Yuan
KY
Pan
Mei-Hsiu
MH
Hong
Ruey-Long
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods / Q000706:statistics & numerical data*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D051598:Whole Body Imaging / Q000379:methods / Q000706:statistics & numerical data*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18