Having advantage for organ preservation and systemic control, induction chemotherapy (ICT) using docetaxel, cisplatin and 5-FU (DCF) followed concurrent chemoradiotherapy (CCRT) has been used for nonsurgical management of locally advanced head and neck squamous cell carcinoma (HNSCC). Early prediction of efficacy of CCRT could be helpful to select patients with more effective in surgery than CCRT. We evaluated the role of interim 18-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) after ICT as a prediction of the efficacy of CCRT and clinical outcomes.
Tumor responses were retrospectively reviewed based on Response Evaluation Criteria in Solid Tumors after ICT and CCRT in locally advanced HNSCC. FDG-PET/CT scans were performed in all patients before and after three cycles of DCF. We examined the association of metabolic response by the percentage decrease of maximum standardized uptake value (SUVmax) after ICT with complete response (CR) to CCRT and clinical outcomes including progression-free survival (PFS) and overall survival (OS).
Forty-four patients with locally advanced HNSCC were evaluated with a median follow-up of 31.7 months. The SUVmax after ICT from baseline was more decreased in CR to CCRT group than non-CR group (78.8% vs. 62.5%, p = 0.004). A 78% decrease of SUVmax after ICT from baseline predicted CR after CCRT (59.3% vs. 17.6%, p = 0.012), PFS (median, not reached vs. 15.0 months, p = 0.002) and OS (median, not reached vs. 43.3 months, p = 0.005) of the patients.
The SUVmax on interim FDG-PET after ICT could be useful to select patients benefitting from CCRT in locally advanced HNSCC and to predict survival outcomes.
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All authors have declared no conflicts of interest.