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Impact of primary tumor size, standardized uptake values of primary tumor, and the most avid neck node on baseline 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography upon disease recurrence in head-and-neck oropharyngeal squamous cell carcinoma using standardized imaging protocol


1 Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
2 Dow Medical College, Dow University Health Sciences, Karachi, Pakistan
3 Department of Medicine, Kings County Hospital/SUNY Downstate Hospital, New York, USA
4 Radiation Oncology, The Aga Khan University Hospital, Karachi, Pakistan

Correspondence Address:
Maseeh uz Zaman,
Department of Radiology, The Aga Khan University Hospital, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/wjnm.wjnm_1_21

The purpose of this prospective study was to find the impact of primary tumor size (Ts), standardized uptake values (SUVmax) of primary tumor, and the most avid neck node on disease recurrence in patients with head-and-neck (HN) oropharyngeal squamous cell carcinoma (HNOP-SCC). We included patients with HNOP-SCC (without distant metastasis – M0 disease) who had pre- and post-treatment 18-fluoro-2-deoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT) using strict standardized imaging protocol from 2017 to 2019. Based on follow-up 18FDG PET/CT findings patients were categorized as disease free (no or minimal 18FDG uptake ≤ background over surgical bed and no distant metastasis) and disease recurrence (18FDG uptake > background over surgical bed with or without nodal and/or distant metastasis). Ts and SUVmax of primary tumor and the most avid neck node were compared and impact of these was studied upon disease recurrence. A total of 112 patients were included. No significant difference was seen in mean age (overall: 60 ± 14 year), gender distribution (overall M: F: 69:31%), body mass index (overall: 25.20 ± 5.82), and history of diabetes (overall: 19%) between disease free and disease recurrence groups. Similarly, no significant difference was observed for fasting blood sugar (overall: 110 ± 28 mg%), 18FDG dose (overall: 169 ± 37 MBq) and uptake period (overall: 70 ± 12 min) between two groups ensuring strict adherence to standardized imaging protocol. Significant difference (P < 0.05) was observed between disease free and disease recurrence for Ts (25 ± 10 mm vs. 33 ± 14 mm), SUVmax of primary tumor (6.2 ± 6.8 vs. 9.3 ± 7.2) and the most avid neck node (2.1 ± 3.3 vs. 4.7 ± 5.9) and median follow-up (13 ± 12 vs. 08 ± 13 months), respectively. Using receiver operating characteristic analysis, Ts >29 mm, baseline tumor SUVmax >4.6 and nodal SUVmax >6.2 were found independent predictors for disease recurrence. Nodal SUVmax >6.2 was found an independent predictor of shortest DFS than Ts and tumor SUVmax. We conclude that, in HNOP-SCC, primary Ts (>29 mm), SUVmax of primary tumor (>4.6), and the most avid neck node (>6.2) in baseline 18FDG PET/CT using standardized imaging protocol are the independent predictors of disease recurrence. Furthermore, SUVmax >6.2 of the most avid node predicts the shortest DFS than primary Ts and SUVmax of primary tumor.


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