2-[18F]-Fluoro-2-deoxy-d-glucose positron emission tomography as guidance for primary treatment in patients with advanced-stage resectable squamous cell carcinoma of the larynx and hypopharynx

BackgroundHigh uptake of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) is associated with unfavorable results. Pretreatment FDG uptake was evaluated as a predictor of survival and guidance for primary surgery or radiotherapy (RT) in patients with squamous cell carcinoma (SCC) of the larynx and hypopharynx.Materials and methodsSeventy-nine consecutive patients with newly diagnosed advanced resectable SCC of the larynx and hypopharynx underwent FDG positron emission tomography (PET) before surgical resection plus RT and chemotherapy (surgery group, n = 40) or RT with chemotherapy and surgical salvage (RT group, n = 39). Age, tumor stage, histological grade, treatment strategy, and standardized uptake value (SUV) were analyzed for association with local control and survival.ResultsOverall local control and survival in the two groups did not differ (P > 0.1). In univariate analysis, nodal positivity (P = 0.014) and SUV > 8.0 (P = 0.007) were associated with poorer disease-free survival (DFS). In multivariate analysis, SUV remained an independent determinant of DFS (P = 0.014). When patients with SUV > 8.0 in the two treatment groups were analyzed separately, those in the surgery group tended to have a higher 3-year DFS than those in the RT group, despite no statistical significance (48% vs. 27%, P = 0.085).ConclusionsHigh FDG uptake is associated with poor survival in patients with advanced laryngopharyngeal SCC. Patients with high FDG uptake may be better treated by surgical resection followed by RT and chemotherapy.