Therapy response assessment and patient outcomes in head and neck squamous cell carcinoma

FDG PET hopkins criteria versus residual neck node size and morphologic features

Rick Arthur Wray, Sara Sheikhbahaei, Charles Marcus, Elcin Zan, Regan Ferraro, Arman Rahmim, Rathan M. Subramaniam

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE. This study investigates the prognostic value of 18F-FDG PET/CT qualitative therapy assessment (Hopkins criteria) in patients with head and neck squamous cell carcinomas (HNSCCs) with residual neck nodes after definitive chemoradiation therapy and compares the Hopkins criteria with anatomic nodal size and morphologic features for prediction of survival outcomes. MATERIALS AND METHODS. A total of 72 patients with HNSCC, with negative primary tumor and positive residual neck nodes (CT criteria > 1 cm short-axis diameter) after the completion of definitive chemoradiation therapy, were included. PET/CT was performed 6-24 weeks after completion of treatment. FDG uptake in residual nodes on PET/CT was interpreted using a structured qualitative 5-point scale (Hopkins criteria). The 5-point scale was dichotomized to negative (scores 1, 2, and 3) or positive (scores 4 and 5) results. Cystic or necrotic nodes were defined as those with central low attenuation with a relatively hyperdense capsule. Kaplan-Meier curve and Cox regression analysis were performed. RESULTS. On the basis of the Hopkins criteria, 10 (13.9%) patients had positive findings and 62 (86.1%) had negative findings for residual nodal disease. According to CT interpretation, 25 patients (34.7%) had residual cervical lymph nodes greater than or equal to 1.5 cm in diameter, and 41 (56.9%) patients had cystic or necrotic nodes. Patients were followed for a median of 27 months after posttherapy PET/CT. There was a statistically significant difference in overall survival (OS) (hazard ratio, 7.06; p < 0.001) and progression-free survival (PFS) (hazard ratio, 6.18; p < 0.001) between patients with negative versus positive residual FDG nodal uptake. There was no statistically significant difference in OS and PFS in patients categorized on the basis of nodal size or morphologic features. CONCLUSION. PET-based structured qualitative therapy assessment (Hopkins criteria) can predict survival outcomes of patients with HNSCC with residual neck nodes after definitive chemoradiotherapy.

Original languageEnglish (US)
Pages (from-to)641-647
Number of pages7
JournalAmerican Journal of Roentgenology
Volume207
Issue number3
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

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Patient Outcome Assessment
Neck
Therapeutics
Survival
Disease-Free Survival
Carcinoma, squamous cell of head and neck
Fluorodeoxyglucose F18
Residual Neoplasm
Chemoradiotherapy
Capsules
Lymph Nodes
Regression Analysis

Keywords

  • CT
  • Head and neck squamous cell carcinoma
  • PET/CT
  • Survival
  • Therapy assessment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Therapy response assessment and patient outcomes in head and neck squamous cell carcinoma : FDG PET hopkins criteria versus residual neck node size and morphologic features. / Wray, Rick Arthur; Sheikhbahaei, Sara; Marcus, Charles; Zan, Elcin; Ferraro, Regan; Rahmim, Arman; Subramaniam, Rathan M.

In: American Journal of Roentgenology, Vol. 207, No. 3, 01.09.2016, p. 641-647.

Research output: Contribution to journalArticle

Wray, Rick Arthur ; Sheikhbahaei, Sara ; Marcus, Charles ; Zan, Elcin ; Ferraro, Regan ; Rahmim, Arman ; Subramaniam, Rathan M. / Therapy response assessment and patient outcomes in head and neck squamous cell carcinoma : FDG PET hopkins criteria versus residual neck node size and morphologic features. In: American Journal of Roentgenology. 2016 ; Vol. 207, No. 3. pp. 641-647.
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abstract = "OBJECTIVE. This study investigates the prognostic value of 18F-FDG PET/CT qualitative therapy assessment (Hopkins criteria) in patients with head and neck squamous cell carcinomas (HNSCCs) with residual neck nodes after definitive chemoradiation therapy and compares the Hopkins criteria with anatomic nodal size and morphologic features for prediction of survival outcomes. MATERIALS AND METHODS. A total of 72 patients with HNSCC, with negative primary tumor and positive residual neck nodes (CT criteria > 1 cm short-axis diameter) after the completion of definitive chemoradiation therapy, were included. PET/CT was performed 6-24 weeks after completion of treatment. FDG uptake in residual nodes on PET/CT was interpreted using a structured qualitative 5-point scale (Hopkins criteria). The 5-point scale was dichotomized to negative (scores 1, 2, and 3) or positive (scores 4 and 5) results. Cystic or necrotic nodes were defined as those with central low attenuation with a relatively hyperdense capsule. Kaplan-Meier curve and Cox regression analysis were performed. RESULTS. On the basis of the Hopkins criteria, 10 (13.9{\%}) patients had positive findings and 62 (86.1{\%}) had negative findings for residual nodal disease. According to CT interpretation, 25 patients (34.7{\%}) had residual cervical lymph nodes greater than or equal to 1.5 cm in diameter, and 41 (56.9{\%}) patients had cystic or necrotic nodes. Patients were followed for a median of 27 months after posttherapy PET/CT. There was a statistically significant difference in overall survival (OS) (hazard ratio, 7.06; p < 0.001) and progression-free survival (PFS) (hazard ratio, 6.18; p < 0.001) between patients with negative versus positive residual FDG nodal uptake. There was no statistically significant difference in OS and PFS in patients categorized on the basis of nodal size or morphologic features. CONCLUSION. PET-based structured qualitative therapy assessment (Hopkins criteria) can predict survival outcomes of patients with HNSCC with residual neck nodes after definitive chemoradiotherapy.",
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T2 - FDG PET hopkins criteria versus residual neck node size and morphologic features

AU - Wray, Rick Arthur

AU - Sheikhbahaei, Sara

AU - Marcus, Charles

AU - Zan, Elcin

AU - Ferraro, Regan

AU - Rahmim, Arman

AU - Subramaniam, Rathan M.

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N2 - OBJECTIVE. This study investigates the prognostic value of 18F-FDG PET/CT qualitative therapy assessment (Hopkins criteria) in patients with head and neck squamous cell carcinomas (HNSCCs) with residual neck nodes after definitive chemoradiation therapy and compares the Hopkins criteria with anatomic nodal size and morphologic features for prediction of survival outcomes. MATERIALS AND METHODS. A total of 72 patients with HNSCC, with negative primary tumor and positive residual neck nodes (CT criteria > 1 cm short-axis diameter) after the completion of definitive chemoradiation therapy, were included. PET/CT was performed 6-24 weeks after completion of treatment. FDG uptake in residual nodes on PET/CT was interpreted using a structured qualitative 5-point scale (Hopkins criteria). The 5-point scale was dichotomized to negative (scores 1, 2, and 3) or positive (scores 4 and 5) results. Cystic or necrotic nodes were defined as those with central low attenuation with a relatively hyperdense capsule. Kaplan-Meier curve and Cox regression analysis were performed. RESULTS. On the basis of the Hopkins criteria, 10 (13.9%) patients had positive findings and 62 (86.1%) had negative findings for residual nodal disease. According to CT interpretation, 25 patients (34.7%) had residual cervical lymph nodes greater than or equal to 1.5 cm in diameter, and 41 (56.9%) patients had cystic or necrotic nodes. Patients were followed for a median of 27 months after posttherapy PET/CT. There was a statistically significant difference in overall survival (OS) (hazard ratio, 7.06; p < 0.001) and progression-free survival (PFS) (hazard ratio, 6.18; p < 0.001) between patients with negative versus positive residual FDG nodal uptake. There was no statistically significant difference in OS and PFS in patients categorized on the basis of nodal size or morphologic features. CONCLUSION. PET-based structured qualitative therapy assessment (Hopkins criteria) can predict survival outcomes of patients with HNSCC with residual neck nodes after definitive chemoradiotherapy.

AB - OBJECTIVE. This study investigates the prognostic value of 18F-FDG PET/CT qualitative therapy assessment (Hopkins criteria) in patients with head and neck squamous cell carcinomas (HNSCCs) with residual neck nodes after definitive chemoradiation therapy and compares the Hopkins criteria with anatomic nodal size and morphologic features for prediction of survival outcomes. MATERIALS AND METHODS. A total of 72 patients with HNSCC, with negative primary tumor and positive residual neck nodes (CT criteria > 1 cm short-axis diameter) after the completion of definitive chemoradiation therapy, were included. PET/CT was performed 6-24 weeks after completion of treatment. FDG uptake in residual nodes on PET/CT was interpreted using a structured qualitative 5-point scale (Hopkins criteria). The 5-point scale was dichotomized to negative (scores 1, 2, and 3) or positive (scores 4 and 5) results. Cystic or necrotic nodes were defined as those with central low attenuation with a relatively hyperdense capsule. Kaplan-Meier curve and Cox regression analysis were performed. RESULTS. On the basis of the Hopkins criteria, 10 (13.9%) patients had positive findings and 62 (86.1%) had negative findings for residual nodal disease. According to CT interpretation, 25 patients (34.7%) had residual cervical lymph nodes greater than or equal to 1.5 cm in diameter, and 41 (56.9%) patients had cystic or necrotic nodes. Patients were followed for a median of 27 months after posttherapy PET/CT. There was a statistically significant difference in overall survival (OS) (hazard ratio, 7.06; p < 0.001) and progression-free survival (PFS) (hazard ratio, 6.18; p < 0.001) between patients with negative versus positive residual FDG nodal uptake. There was no statistically significant difference in OS and PFS in patients categorized on the basis of nodal size or morphologic features. CONCLUSION. PET-based structured qualitative therapy assessment (Hopkins criteria) can predict survival outcomes of patients with HNSCC with residual neck nodes after definitive chemoradiotherapy.

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