title: Intratumor Textural Heterogeneity on Pretreatment (18)F-FDG PET Images Predicts Response and Survival After Chemoradiotherapy for Hypopharyngeal Cancer.
abstract: BACKGROUND
  Increasing evidence suggests that intratumor heterogeneity of solid tumors characterized by textural features on 18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) images is associated with response to chemoradiotherapy (CRT) and survival. The current study aimed to determine whether a similar relationship exists in hypopharyngeal squamous cell carcinoma (HPSCC).
  
  
  METHODS
  This study investigated 27 patients with HPSCC who underwent cisplatin-based induction chemotherapy followed by definitive CRT underwent pretreatment (18)F-FDG PET/CT. Standardized uptake value (SUV), metabolic tumor volume (MTV), and textural features (coarseness, busyness, complexity, and contrast) of primary tumors were measured. Patients were classified as nonresponders or responders according to the response evaluation criteria in solid tumors. The capacity of each parameter to classify response was assessed using the Mann-Whitney U test. Cox-proportional hazard models were used to identify variables associated with disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  Of 70 patients, 58 (83 %) had complete or partial response after CRT. Responders showed lower maximum SUV (P = 0.037), lower MTV (P = 0.039), lower coarseness (P < 0.001), and busyness (P = 0.015) compared with nonresponders. Multivariate analysis showed that high coarseness (P = 0.001, hazard ratio [HR] 5.65; 95 % confidence interval [CI] 2.12-15.07) and busyness (P = 0.045; HR 2.56; 95 % CI 1.02-6.42) were independently associated with poor DFS, and that high coarseness (P = 0.013; HR 2.48; 95 % CI 1.21-5.09) was independently associated with poor OS.
  
  
  CONCLUSIONS
  Abnormal coarseness in baseline (18)F-FDG PET scans may be useful for predicting response and survival after CRT in HPSCC patients.
authors.affiliation: Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jungsu S
authors.initials: JS
authors.lastname: Oh
authors.forename: Bung Chul
authors.initials: BC
authors.lastname: Kang
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Kim
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Sung-Bae
authors.initials: SB
authors.lastname: Kim
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D020266:Radiotherapy, Conformal; D066066:Response Evaluation Criteria in Solid Tumors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin