Use of baseline 18F-FDG PET scan to identify initial sub-volumes with local failure after concomitant radio-chemotherapy in head and neck cancer

INTRODUCTION: Head and neck squamous cell carcinoma (HNSCC) treated by radio-chemotherapy have a significant local recurrence rate. It has been previously suggested that 18F-FDG PET could identify the high uptake areas that can be potential targets for dose boosting. The purpose of this study was to compare the location of initial hypermetabolic regions on baseline scans with the metabolic relapse sites after radio-chemotherapy in HNSCC. RESULTS: The initial functional tumor volume was significantly higher for patients with proven local recurrence or residual disease (23.5 cc vs. 8.9 cc; p = 0.0005). The overlap between baseline and follow-up sub-volumes were moderate with an overlap fraction ranging from 0.52 to 0.39 between R40 and I30 to I60. CONCLUSION: In our study the overlap between baseline and post-therapeutic metabolic tumor sub-volumes was only moderate. These results need to be investigated in a larger cohort acquired with a more standardized patient repositioning protocol for sequential PET imaging. METHODS: Pre and post treatment PET/CT scans of ninety four HNSCC patients treated with radio-chemotherapy were retrospectively reviewed. Follow-up 18F-FDG PET/CT images were registered to baseline scans using a rigid body transformation. Seven metabolic tumor sub-volumes were obtained on the baseline scans using a fixed percentage of SUV(max) (I30, I40, I50, I60, I70, I80, and I90) and were subsequently compared with two post-treatment sub-volumes (R40, R90) in 38 cases of local recurrence or residual metabolic disease. Overlap fraction, Dice and Jaccard indices, common volume/baseline volume and common volume/recurrent volume were used to determine the overlap of the different estimated sub-volumes.