Use of 18F-FDG PET for primary treatment strategy in patients with squamous cell carcinoma of the oropharynx.
High tumor uptake of (18)F-FDG is associated with an unfavorable outcome in cancer patients. We evaluated pretreatment (18)F-FDG uptake as guidance for the primary treatment modality in patients with squamous cell carcinoma (SCC) of the oropharynx.


METHODS
Fifty-two consecutive patients with newly diagnosed resectable SCC of the oropharynx underwent (18)F-FDG PET before treatment. Primary treatment modalities consisted of surgical resection plus radiotherapy (RT) (surgery group, n=31) or radical RT plus chemotherapy (RT group, n=21). The sex, age, tumor stage, histologic grade, TNM classification, treatment strategy, and maximum standardized uptake value (SUV) categories were analyzed for association with local control (LC) and disease-free survival (DFS). The median follow-up of the surviving patients was 36 mo.


RESULTS
The median SUV was significantly higher in the 11 patients who failed treatment than that in the remaining controlled patients (8.0 vs. 5.4; P=0.021). Patients having tumors with a high SUV > 6.0 had poorer LC and DFS (P<0.05). In multivariate analysis, the SUV remained an independent determinant of LC and DFS (P<0.05). Patients with a SUV > 6.0 in the surgery group had a higher 3-y DFS than that in the RT group (78% vs. 33%; P=0.043).


CONCLUSIONS
Pretreatment tumor (18)F-FDG uptake represents an independent prognostic factor in patients with oropharyngeal SCC. Patients with high (18)F-FDG uptake may be better treated by surgery followed by RT with or without chemotherapy, which needs to be verified by a prospective randomized study.
Kim
Sang Yoon
SY
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Roh
Jong-Lyel
JL
Kim
Mi Ra
MR
Kim
Jae Seung
JS
Choi
Seung-Ho
SH
Nam
Soon Yuhl
SY
Lee
Sang-wook
SW
Kim
Sung-Bae
SB
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D049268:Positron-Emission Tomography / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18