Prognostic Value Comparison Between 18F-FLT PET/CT and 18F-FDG PET/CT Volume-Based Metabolic Parameters in Patients with Head and Neck Cancer

Purpose: The present study compared the potential of pretreatment 3'-deoxy-3'-[F-18]-fluorothymidine (F-18-FLT) uptake parameters and those of F-18-FDG to predict the clinical outcome of head and neck squamous cell carcinoma treated with chemoradiotherapy. Methods: A total 53 patients undergoing pretreatment F-18-FLT PET/CTand F-18-FDG PET/CT from May 2006 to April 2013 were evaluated. The SUVmax, metabolic tumor volume (MTV), total lesion glycolysis, and total lesion proliferation (TLP) were determined semiquantitatively. Associations between clinical factors and PET/CT parameters and prognostic value were analyzed. Results: In univariate analyses, F-18-FLT SUVmax, MTV, TLP, F-18-FDG MTV, and total lesion glycolysis correlated with locoregional control (P = 0.02, P = 0.0007, P = 0.0001, P = 0.007, and P = 0.013, respectively). Clinical T stage, F-18-FLT SUVmax, MTV, TLP, and F-18-FDG SUVmax correlated with overall survival (P = 0.012, P = 0.0057, P = 0.0018, P = 0.0012, and P = 0.047, respectively). On multivariate analyses, F-18-FLT TLP was an independent factor for locoregional control (P = 0.002; hazards ratio [HR], 5.13; 95% confidence interval [CI], 1.81-14.54), as were F-18-FLT SUVmax and MTV for overall survival (P = 0.021; HR, 3.47; 95% CI, 1.2-10.01 and P = 0.029; HR, 3.17; 95% CI, 1.12-8.95). Conclusions: Pretreatment F-18-FLT PET/CT volume-based metabolic parameters are superior prognostic predictors to those of F-18-FDG PET/CT. F-18-FLT SUVmax and MTV can provide important prognostic information for patients with head and neck squamous cell carcinomas administered with chemoradiotherapy.