18F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT

James E. Jackson, Nigel J. Anderson, Maureen Rolfo, Morikatsu Wada, Michal Schneider, Michael Poulsen, Maziar Fahandej, Anna Huynh, Sze Ting Lee, Daryl Lim Joon, Vincent Khoo

Research output: Contribution to journalArticleResearchpeer-review

Abstract

The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.

Original languageEnglish
Pages (from-to)341-349
Number of pages9
JournalDysphagia
Volume34
Issue number3
DOIs
Publication statusPublished - Jun 2019

Keywords

  • Enteral nutrition
  • Head & neck neoplasms
  • Positron-emission tomography
  • Radiotherapy
  • Toxicity

Cite this

Jackson, James E. ; Anderson, Nigel J. ; Rolfo, Maureen ; Wada, Morikatsu ; Schneider, Michal ; Poulsen, Michael ; Fahandej, Maziar ; Huynh, Anna ; Lee, Sze Ting ; Joon, Daryl Lim ; Khoo, Vincent. / 18F-FDG Metabolic Tumor Volume : Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT. In: Dysphagia. 2019 ; Vol. 34, No. 3. pp. 341-349.
@article{b1d4ef31dee749f9858f25751cdd8341,
title = "18F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT",
abstract = "The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8{\%} vs. 69.5{\%}, p = 0.0067) and FT dependence at six weeks (76.7{\%} vs. 41.7{\%}, p = 0.0024) and six months (25.0{\%} vs. 8.7{\%}, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.",
keywords = "Enteral nutrition, Head & neck neoplasms, Positron-emission tomography, Radiotherapy, Toxicity",
author = "Jackson, {James E.} and Anderson, {Nigel J.} and Maureen Rolfo and Morikatsu Wada and Michal Schneider and Michael Poulsen and Maziar Fahandej and Anna Huynh and Lee, {Sze Ting} and Joon, {Daryl Lim} and Vincent Khoo",
year = "2019",
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Jackson, JE, Anderson, NJ, Rolfo, M, Wada, M, Schneider, M, Poulsen, M, Fahandej, M, Huynh, A, Lee, ST, Joon, DL & Khoo, V 2019, '18F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT' Dysphagia, vol. 34, no. 3, pp. 341-349. https://doi.org/10.1007/s00455-018-9946-z

18F-FDG Metabolic Tumor Volume : Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT. / Jackson, James E.; Anderson, Nigel J.; Rolfo, Maureen; Wada, Morikatsu; Schneider, Michal; Poulsen, Michael; Fahandej, Maziar; Huynh, Anna; Lee, Sze Ting; Joon, Daryl Lim; Khoo, Vincent.

In: Dysphagia, Vol. 34, No. 3, 06.2019, p. 341-349.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - 18F-FDG Metabolic Tumor Volume

T2 - Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT

AU - Jackson, James E.

AU - Anderson, Nigel J.

AU - Rolfo, Maureen

AU - Wada, Morikatsu

AU - Schneider, Michal

AU - Poulsen, Michael

AU - Fahandej, Maziar

AU - Huynh, Anna

AU - Lee, Sze Ting

AU - Joon, Daryl Lim

AU - Khoo, Vincent

PY - 2019/6

Y1 - 2019/6

N2 - The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.

AB - The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.

KW - Enteral nutrition

KW - Head & neck neoplasms

KW - Positron-emission tomography

KW - Radiotherapy

KW - Toxicity

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DO - 10.1007/s00455-018-9946-z

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