The Role of Pretreatment ¹⁸F-FDG PET/CT for Early Prediction of Neoadjuvant Chemotherapy Response in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

Abstract

Introduction

To evaluate the role of maximal standardized uptake values (SUVmax) and total lesion glycolysis (TLG) from serial ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for early prediction of neoadjuvant chemotherapy (NAC) response in locoregionally advanced nasopharyngeal carcinoma (LANPC).

Methods

A total of 121 LANPC patients who completed pretreatment ¹⁸F-FDG PET/CT between June 2017 and July 2020 were retrospectively included. The median age of all the participants was 50 years old (range: 19–74 years), with 94 (77.7%) males and 27 (22.3%) females. The SUVmax from the primary tumor site (SUVmax-PT) and the total lesion glycolysis from the primary tumor site (TLG-PT) were recorded. Tumor response was calculated according to the Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 Criteria at two-week post-secondary NAC cycle. Patients who achieved an objectively partial or full reaction after two cycles of NAC were defined as ‘responders’, and patients who obtained stability or progression were classified as ‘non-responders’.

Results

After two cycles of NAC, 96 patients were categorized as “responders” and 25 patients as “non-responders”. The optimal thresholds of the SUVmax-PT were 11.8 and 38.5 for the TLG-PT. Non-responders were significantly associated with high SUVmax-PT (HR, 3.49; 95% CI, 1.17–10.36; p = 0.024) and TLG-PT (HR, 4.45; 95% CI, 1.44–13.78; p = 0.010) in multivariate analysis. Recursive partitioning analysis (RPA) categorized patients into three prognostic groups based on SUVmax-PT and TLG-PT: high-response group, intermediate-response group, and low-response group, with corresponding favorable response rates of 94%, 80%, and 55%, respectively. Moreover, a nomogram was created based on metabolic parameters that precisely projected an individual’s response of NAC (C-index, 0.787; 95% CI, 0.533–1.000).

Conclusion

Pretreatment ¹⁸F-FDG PET/CT to measure SUVmax-PT and TLG-PT could be a useful non-invasive method for early indication of NAC efficacy. The nomogram based on PET/CT parameters may potentially provide direction for treatment decisions based on NAC levels.

Keywords:

• nasopharyngeal carcinoma
• neoadjuvant chemotherapy
• tumor response
• PET/CT
• nomogram

Acknowledgments

We would like to acknowledge and thank the patients who participated in the study. Moreover, the authors appreciate Dr. Jiebing Gao and Dr. Guojie Wang from the Department of Radiology who specialized in head and neck MRI, which evaluated the treatment response in MRI.

Data Sharing Statement

Datasets can be retrieved from the corresponding author (Hong Shan) upon formal request from interested readers. Datasets cannot be directly shared with public repositories due to the National Personal Data Protection Act.

Author Contributions

All authors contributed to data analysis, drafting or revising of the article, gave final approval for the version to be published, agreed to the submitted journal, and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by grants from the National Key R&D Program of China (No. 2018YFC0910600), the National Natural Science Foundation of China (No. 81901699, 81871382),and the Nursing Research Project of Guangdong Nursing Association (No. gdhlxueh2019zx072).