Uptake of 18F-FLT and 18F-FDG in primary head and neck cancer correlates with survival

A. Linecker; C. Kermer; I. Sulzbacher; P. Angelberger; K. Kletter; R. Dudczak; R. Ewers; A. Becherer

doi:10.3413/nukmed-0128

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2008; 47(02): 80-85
DOI: 10.3413/nukmed-0128

Originalarbeiten

Schattauer GmbH

Uptake of ¹⁸F-FLT and ¹⁸F-FDG in primary head and neck cancer correlates with survival

¹⁸F-FLT- und ¹⁸F-FDG- Uptake korrellieren mit dem Überleben bei Kopf-Hals-Tumoren

Authors

A. Linecker

¹Departments of Craniomaxillofacial Surgery
C. Kermer

¹Departments of Craniomaxillofacial Surgery
I. Sulzbacher

³Departments of Pathology
P. Angelberger

⁴University of Vienna, ARC Seibersdorf Research GmbH, Seibersdorf
K. Kletter

²Departments of Nuclear Medicine
R. Dudczak

²Departments of Nuclear Medicine
R. Ewers

¹Departments of Craniomaxillofacial Surgery
A. Becherer

²Departments of Nuclear Medicine

⁵Department of Department of Nuclear Medicine, LKH Feldkirch, Austria

Abstract

Summary

The aim of the study was to determine the practicability of ¹⁸F-FLT in tumours of the head and neck area in terms of visualization, a possible correlation between FLT uptake and proliferation fraction as determined by Ki-67 immunostaining, and if tumoural FLT-uptake has a prognostic meaning, as determined by a correlation to patient survival time. Results were compared to ¹⁸F-FDG. Patients, methods: 20 patients with previously untreated lesions of the head and neck area, which were clinically highly suspicious to be malignant, underwent PET scans with ¹⁸F-FLT and ¹⁸F-FDG, a CT of the head and neck area, and a biopsy. Tumour tracer uptake was determined by standardized uptake value (SUV) normalized to body weight and /non-tumor ratios (T/N). ¹⁸F-FDG and ¹⁸F-FLT uptake were compared with histopathologic and immunohistochemical results. Results: 19 patients had malignant tumours; one patient had a benign cystadenoma (so called Warthin's tumour) of the parotid gland. One negative lesion turned out to be a malignant T1 stage squamous cell carcinoma in both PET scans, the Warthin's tumour was false positive with ¹⁸F-FDG but showed only faint uptake with ¹⁸F-FLT, resulting in a sensitivity of 95 % for both tracers. Of all lesions, maximum SUVs of ¹⁸F-FLT ranged from 1.53 to 11.70 (mean ± SD 5.81 ± 2.28) those of FDG from 2.63 to 16.50 (mean ± SD 8.91 ± 3.58), p < 0.001. ¹⁸F-FLT-T/N ranged from 0.94 to 5.85 (mean ± SD, 3.18 ± 1.21), ¹⁸F-FDG-T/N was from 0.92 to 7.50 (mean ± SD, 3.6 ± 1.74), n.s. The mean survival time was 18 months in a maximum follow up time of 36 months. A significant correlation between both PET tracers and survival was detected, but no correlation between the amount of Ki-67 positive cells and FLT. Conclusion: In head and neck cancer in the primary setting ¹⁸F-FLT does not provide additional visual information in comparison to ¹⁸F-FDG.¹⁸F-FLT uptake is inversely correlated with patient survival, as well as ¹⁸F-FDG.

Zusammenfassung

Ziel dieser Arbeit war die Frage zu klären, ob bei Kopf-Hals-Tumoren der Einsatz von ¹⁸F-FLT gegenüber ¹⁸F-FDG eine signifikante Mehrinformation liefert. Zusätzlich sollte gezeigt werden, ob mögliche Korrelationen zwischen der tumoralen FLT-Aufnahme, der Ki-67-Wachstumsfraktion oder der Überlebenszeit bestehen. Patienten, Methoden: 20 Patienten mit unbehandelten Läsionen des Kopf-Hals-Bereiches, welche klinisch hochsuspekt als maligner Tumor imponierten, wurden mit ¹⁸F-FLT und ¹⁸F-FDG untersucht. Die tumorale Traceraufnahme wurde bestimmt mittels Körpergewicht-normiertem SUV (standardized uptake value) und in Relation zur kontralateralen Region gesetzt (Tumor/ Nichttumor-Ratio, T/N). Innerhalb der ersten zwei Wochen nach dem ersten Ambulanzbesuch wurden beide PET-Untersuchungen, ein CT des Gesichtsschädels sowie eine Biopsie durchgeführt. Die Ergebnisse der¹⁸F-FDG und ¹⁸F-FLT PET-Untersuchung wurden mit histopathologischen und immunhistochemischen Ergebnissen verglichen. Ergebnisse: 19 Patienten hatten einen malignen Tumor, ein Patient hatte ein Zystadenolymphom der Parotis (Warthin-Tumor). Eine negative Läsion war in beiden PET-Untersuchungen ein malignes Plattenepithelkarzinom T1-stadium, der Warthin-Tumor war falsch positiv in der ¹⁸F-FDGUntersuchung, hatte aber nur eine minimale Speicherung mit ¹⁸F-FLT-PET gezeigt. Daraus resultierte eine Sensitivität von 95% für beide Tracer. Die maximalen SUVs von ¹⁸F-FLT reichten von 1,53 bis 11,70 (MW ± SD 5,81 ± 2,28), die von FDG 2,63 bis 16,50 (MW ± SD 8,91 ± 3,58), p < 0,001. ¹⁸F-FLT-T/N reichte von 0,94 bis 5,85 (MW ± SD, 3,18 ± 1,21), ¹⁸F-FDG-T/N reichte von 0,92 bis 7,50 (mean ± SD 3,6 ± 1.74), n.s. Die mittlere Überlebenszeit betrug 18 Monate bei einem Beobachtungszeitraum von maximal 36 Monaten. Eine signifikante Korrelation zwischen beiden Tracern und der Überlebenszeit wurde festgestellt, aber keine Korrelation zwischen der Anzahl der Ki-67-positiven Zellen und FLT. Schlussfolgerung: Bei Kopf-Hals-Tumoren lieferte¹⁸F-FLT keine zusätzliche Information im Vergleich zu ¹⁸F-FDG. Die SUVs beider Tracer zeigten eine schwache, aber signifikante inverse Korrelation mit der Überlebenszeit.

Keywords

Head-and-neck cancer - fluorothymidine - fluorodeoxy-glucose - PET - prognosis - survival

Schlüsselwörter

Kopf-Hals-Tumore - Fluorthymidin - Fluordesoxyglukose - PET - Prognose - Überlebenszeit

Full Text

References

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