DOI: 10.1007/s00259-018-4172-3Pages: 1-11

Value of early evaluation of treatment response using 18F-FDG PET/CT parameters and the Epstein-Barr virus DNA load for prediction of outcome in patients with primary nasopharyngeal carcinoma

1. Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Department of Nuclear Medicine

2. Linkou Chang Gung Memorial Hospital and Chang Gung University, Department of Otorhinolaryngology

3. Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Department of Hematology and Oncology

4. Linkou Chang Gung Memorial Hospital and Chang Gung University, Department of Nuclear Medicine

5. Tzu Chi General Hospital, Epidemiology and Biostatistics Consulting Center, Department of Medical Research and Department of Pharmacy

6. Linkou Chang Gung Memorial Hospital and Chang Gung University, Department of Radiation Oncology

7. Linkou Chang Gung Memorial Hospital and Chang Gung University, Division of Medical Oncology, Department of Internal Medicine

8. Linkou Chang Gung Memorial Hospital and Chang Gung University, Department of Diagnostic Radiology

9. Tzu Chi University of Science and Technology, Department of Medical Imaging and Radiological Sciences

Correspondence to:
Sheng-Chieh Chan
Email: williamsm.tw@gmail.com

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Abstract

Purpose

To determine the value of early evaluation of response to concurrent chemoradiotherapy (CCRT) using 18F-FDG PET-derived parameters and the Epstein-Barr virus (EBV) DNA titre in outcome prediction in patients with primary nasopharyngeal carcinoma (NPC).

Methods

Sixty patients with primary NPC were prospectively enrolled. All patients underwent 18F-FDG PET/CT before and during CCRT. The plasma EBV DNA titre was measured along with the PET/CT-derived parameters. Changes in EBV DNA titre and PET/CT-derived parameters during CCRT were analysed in relation to response to treatment, recurrence-free survival (RFS) and overall survival (OS).

Results

A total lesion glycolysis (TLG) reduction ratio of ≤0.6 and a detectable EBV DNA titre during CCRT were predictors of an unfavourable response to treatment, RFS and OS. In multivariate analysis, a TLG reduction ratio of ≤0.6 predicted incomplete remission (p = 0.002) and decreased RFS (p = 0.003). The proportion of patients with a TLG reduction ratio of >0.6 who achieved a complete response was more than twice that of patients with a TLG reduction ratio of ≤0.6. A detectable EBV DNA titre, a TLG reduction ratio of ≤0.6 and older age were independently associated with a poorer OS (p = 0.037, 0.009 and 0.016, respectively). A scoring system was developed based on these independent predictors of OS. Patients with a score of 1 and 2/3 had poorer survival outcomes than those with a score of 0 (hazard ratio 4.756, p = 0.074, and hazard ratio 18.973, p = 0.001, respectively). This scoring system appeared to be superior to the traditional TNM staging system (p < 0.001 versus p = 0.175).

Conclusion

Early evaluation of response to CCRT using 18F-FDG PET-derived parameters and the EBV DNA titre can predict outcome in patients with primary NPC. A combination of interim PET parameters and the EBV DNA titre enables better stratification of patients into subgroups with different survival rates.

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  • Accepted: Sep 17, 2018
  • Online: Sep 27, 2018

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