F18-FDG PET/CT imaging early predicts pathologic complete response to induction chemoimmunotherapy of locally advanced head and neck cancer: preliminary single-center analysis of the checkrad-cd8 trial

  • Aim: In the CheckRad-CD8 trial patients with locally advanced head and neck squamous cell cancer are treated with a single cycle of induction chemo-immunotherapy (ICIT). Patients with pathological complete response (pCR) in the re-biopsy enter radioimmunotherapy. Our goal was to study the value of F-18-FDG PET/CT in the prediction of pCR after induction therapy. Methods: Patients treated within the CheckRad-CD8 trial that additionally received FDG- PET/CT imaging at the following two time points were included: 3–14 days before (pre-ICIT) and 21–28 days after (post-ICIT) receiving ICIT. Tracer uptake in primary tumors (PT) and suspicious cervical lymph nodes (LN +) was measured using different quantitative parameters on EANM Research Ltd (EARL) accredited PET reconstructions. In addition, mean FDG uptake levels in lymphatic and hematopoietic organs were examined. Percent decrease (Δ) in FDG uptake was calculated for all parameters. Biopsy of the PT post-ICIT acquired after FDG-PET/CT served as reference. The cohort was divided in patients with pCR and residual tumor (ReTu). Results: Thirty-one patients were included. In ROC analysis, ΔSUVmax PT performed best (AUC = 0.89) in predicting pCR (n = 17), with a decline of at least 60% (sensitivity, 0.77; specificity, 0.93). Residual SUVmax PT post-ICIT performed best in predicting ReTu (n = 14), at a cutpoint of 6.0 (AUC = 0.91; sensitivity, 0.86; specificity, 0.88). Combining two quantitative parameters (ΔSUVmax ≥ 50% and SUVmax PT post-ICIT ≤ 6.0) conferred a sensitivity of 0.81 and a specificity of 0.93 for determining pCR. Background activity in lymphatic organs or uptake in suspected cervical lymph node metastases lacked significant predictive value. Conclusion: FDG-PET/CT can identify patients with pCR after ICIT via residual FDG uptake levels in primary tumors and the related changes compared to baseline. FDG-uptake in LN + had no predictive value. Trial registry: ClinicalTrials.gov identifier: NCT03426657.

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Author:Michael BeckORCiD, Julius HartwichGND, Markus EcksteinORCiDGND, Daniela Schmidt, Antoniu-Oreste GostianGND, Sarina Müller, Sandra RutznerORCiDGND, Udo Sebastian GaiplGND, Jens Müller-von der GrünORCiDGND, Thomas IllmerGND, Matthias Günther HautmannGND, Gunther KlautkeGND, Johannes DöscherGND, Thomas B. BrunnerORCiDGND, Bálint TamaskovicsORCiDGND, Arndt HartmannGND, Heinrich IroGND, Torsten KuwertGND, Rainer FietkauGND, Markus HechtGND, Sabine SemrauGND
URN:urn:nbn:de:hebis:30:3-835572
DOI:https://doi.org/10.1007/s12149-022-01744-6
ISSN:1864-6433
Parent Title (English):Annals of nuclear medicine
Publisher:Springer Japan
Place of publication:[Erscheinungsort nicht ermittelbar]
Document Type:Article
Language:English
Date of Publication (online):2022/05/10
Date of first Publication:2022/05/10
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2024/04/24
Tag:FDG-PET/CT; HNSCC; Head neck cancer; Immunotherapy; Induction therapy
Volume:36.2022
Issue:7
Page Number:11
First Page:623
Last Page:633
Note:
Open Access funding enabled and organized by Projekt DEAL. The trial was funded by AstraZeneca (ESR-16-12356) and was conducted as investigator sponsored trial.
HeBIS-PPN:519152611
Institutes:Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International