Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer

Pilot results from radiation therapy oncology group protocol 0522

David Schwartz, Jonathan Harris, Min Yao, David I. Rosenthal, Adam Opanowski, Anthony Levering, K. Kian Ang, Andy M. Trotti, Adam S. Garden, Christopher U. Jones, Paul Harari, Robert Foote, John Holland, Qiang Zhang, Quynh Thu Le

Research output: Contribution to journalArticle

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Abstract

Purpose To evaluate candidate fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging biomarkers for head-and-neck chemoradiotherapy outcomes in the cooperative group trial setting. Methods and Materials Radiation Therapy Oncology Group (RTOG) protocol 0522 patients consenting to a secondary FDG-PET/CT substudy were serially imaged at baseline and 8 weeks after radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1-cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40% of SUVmax as threshold were obtained from primary tumor and involved nodes. Results Of 940 patients entered onto RTOG 0522, 74 were analyzable for this substudy. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse local-regional control (hazard ratio 4.01, 95% confidence interval 1.28-12.52, P=.02) and progression-free survival (hazard ratio 2.34, 95% confidence interval 1.02-5.37, P=.05). Although MTV and T stage seemed to correlate (mean MTV 6.4, 13.2, and 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for progression-free survival in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited. Conclusion High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.

Original languageEnglish (US)
Pages (from-to)721-729
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume91
Issue number4
DOIs
StatePublished - Mar 15 2015

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Radiation Oncology
biomarkers
Head and Neck Neoplasms
Tumor Burden
radiation therapy
Radiotherapy
tumors
Biomarkers
cancer
Neoplasms
tomography
Disease-Free Survival
Confidence Intervals
Oropharyngeal Neoplasms
Safety Management
progressions
hazards
bivariate analysis
Chemoradiotherapy
confidence

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer : Pilot results from radiation therapy oncology group protocol 0522. / Schwartz, David; Harris, Jonathan; Yao, Min; Rosenthal, David I.; Opanowski, Adam; Levering, Anthony; Ang, K. Kian; Trotti, Andy M.; Garden, Adam S.; Jones, Christopher U.; Harari, Paul; Foote, Robert; Holland, John; Zhang, Qiang; Le, Quynh Thu.

In: International Journal of Radiation Oncology Biology Physics, Vol. 91, No. 4, 15.03.2015, p. 721-729.

Research output: Contribution to journalArticle

Schwartz, D, Harris, J, Yao, M, Rosenthal, DI, Opanowski, A, Levering, A, Ang, KK, Trotti, AM, Garden, AS, Jones, CU, Harari, P, Foote, R, Holland, J, Zhang, Q & Le, QT 2015, 'Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer: Pilot results from radiation therapy oncology group protocol 0522', International Journal of Radiation Oncology Biology Physics, vol. 91, no. 4, pp. 721-729. https://doi.org/10.1016/j.ijrobp.2014.12.023
Schwartz, David ; Harris, Jonathan ; Yao, Min ; Rosenthal, David I. ; Opanowski, Adam ; Levering, Anthony ; Ang, K. Kian ; Trotti, Andy M. ; Garden, Adam S. ; Jones, Christopher U. ; Harari, Paul ; Foote, Robert ; Holland, John ; Zhang, Qiang ; Le, Quynh Thu. / Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer : Pilot results from radiation therapy oncology group protocol 0522. In: International Journal of Radiation Oncology Biology Physics. 2015 ; Vol. 91, No. 4. pp. 721-729.
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abstract = "Purpose To evaluate candidate fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging biomarkers for head-and-neck chemoradiotherapy outcomes in the cooperative group trial setting. Methods and Materials Radiation Therapy Oncology Group (RTOG) protocol 0522 patients consenting to a secondary FDG-PET/CT substudy were serially imaged at baseline and 8 weeks after radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1-cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40{\%} of SUVmax as threshold were obtained from primary tumor and involved nodes. Results Of 940 patients entered onto RTOG 0522, 74 were analyzable for this substudy. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse local-regional control (hazard ratio 4.01, 95{\%} confidence interval 1.28-12.52, P=.02) and progression-free survival (hazard ratio 2.34, 95{\%} confidence interval 1.02-5.37, P=.05). Although MTV and T stage seemed to correlate (mean MTV 6.4, 13.2, and 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for progression-free survival in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited. Conclusion High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.",
author = "David Schwartz and Jonathan Harris and Min Yao and Rosenthal, {David I.} and Adam Opanowski and Anthony Levering and Ang, {K. Kian} and Trotti, {Andy M.} and Garden, {Adam S.} and Jones, {Christopher U.} and Paul Harari and Robert Foote and John Holland and Qiang Zhang and Le, {Quynh Thu}",
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T1 - Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer

T2 - Pilot results from radiation therapy oncology group protocol 0522

AU - Schwartz, David

AU - Harris, Jonathan

AU - Yao, Min

AU - Rosenthal, David I.

AU - Opanowski, Adam

AU - Levering, Anthony

AU - Ang, K. Kian

AU - Trotti, Andy M.

AU - Garden, Adam S.

AU - Jones, Christopher U.

AU - Harari, Paul

AU - Foote, Robert

AU - Holland, John

AU - Zhang, Qiang

AU - Le, Quynh Thu

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N2 - Purpose To evaluate candidate fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging biomarkers for head-and-neck chemoradiotherapy outcomes in the cooperative group trial setting. Methods and Materials Radiation Therapy Oncology Group (RTOG) protocol 0522 patients consenting to a secondary FDG-PET/CT substudy were serially imaged at baseline and 8 weeks after radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1-cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40% of SUVmax as threshold were obtained from primary tumor and involved nodes. Results Of 940 patients entered onto RTOG 0522, 74 were analyzable for this substudy. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse local-regional control (hazard ratio 4.01, 95% confidence interval 1.28-12.52, P=.02) and progression-free survival (hazard ratio 2.34, 95% confidence interval 1.02-5.37, P=.05). Although MTV and T stage seemed to correlate (mean MTV 6.4, 13.2, and 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for progression-free survival in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited. Conclusion High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.

AB - Purpose To evaluate candidate fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging biomarkers for head-and-neck chemoradiotherapy outcomes in the cooperative group trial setting. Methods and Materials Radiation Therapy Oncology Group (RTOG) protocol 0522 patients consenting to a secondary FDG-PET/CT substudy were serially imaged at baseline and 8 weeks after radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1-cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40% of SUVmax as threshold were obtained from primary tumor and involved nodes. Results Of 940 patients entered onto RTOG 0522, 74 were analyzable for this substudy. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse local-regional control (hazard ratio 4.01, 95% confidence interval 1.28-12.52, P=.02) and progression-free survival (hazard ratio 2.34, 95% confidence interval 1.02-5.37, P=.05). Although MTV and T stage seemed to correlate (mean MTV 6.4, 13.2, and 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for progression-free survival in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited. Conclusion High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.

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