• 5/2/2007
  • South Korea
  • Sang Yoon Kim et al
  • Journal of Nuclear Medicine Vol. 48 No. 5 752-757

High tumor uptake of 18F-FDG is associated with an unfavorable outcome in cancer patients. We evaluated pretreatment 18F-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 18F-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).

Conclusion:
Pretreatment tumor 18F-FDG uptake represents an independent prognostic factor in patients with oropharyngeal SCC. Patients with high 18F-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.

Authors:
Sang Yoon Kim1, Jong-Lyel Roh1, Mi Ra Kim2, Jae Seung Kim3, Seung-Ho Choi1, Soon Yuhl Nam1, Sang-wook Lee4 and Sung-Bae Kim5

Authors’ affiliations:
1 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;
2 Department of Otolaryngology, Bundang Jaesaeng General Hospital, Sungnam, South Korea;
3 Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;
4 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and
5 Department of Internal Medicine (Medical Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea