Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: Tumor SUV mean has superior prognostic value

Kristin A. Higgins, Jenny K. Hoang, Michael C. Roach, Junzo Chino, David S. Yoo, Timothy G. Turkington, David M. Brizel

    Research output: Contribution to journalArticlepeer-review

    107 Scopus citations


    Purpose: To evaluate the prognostic significance of different descriptive parameters in head-and-neck cancer patients undergoing pretreatment [F-18] fluoro-D-glucose-positron emission tomography (FDG-PET) imaging. Patients and Methods: Head-and-neck cancer patients who underwent FDG-PET before a course of curative intent radiotherapy were retrospectively analyzed. FDG-PET imaging parameters included maximum (SUV max), and mean (SUV mean) standard uptake values, and total lesion glycolysis (TLG). Tumors and lymph nodes were defined on co-registered axial computed tomography (CT) slices. SUV max and SUV mean were measured within these anatomic regions. The relationships between pretreatment SUV max, SUV mean, and TLG for the primary site and lymph nodes were assessed using a univariate analysis for disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS). Kaplan-Meier survival curves were generated and compared via the logrank method. SUV data were analyzed as continuous variables. Results: A total of 88 patients was assessed. Two-year OS, LRC, DMFS, and DFS for the entire cohort were 85%, 78%, 81%, and 70%, respectively. Median SUV max for the primary tumor and lymph nodes was 15.4 and 12.2, respectively. Median SUV mean for the primary tumor and lymph nodes was 7 and 5.2, respectively. Median TLG was 770. Increasing pretreatment SUV mean of the primary tumor was associated with decreased disease-free survival (p = 0.01). Neither SUV max in the primary tumor or lymph nodes nor TLG was prognostic for any of the clinical endpoints. Patients with pretreatment tumor SUV mean that exceeded the median value (7) of the cohort demonstrated inferior 2-year DFS relative to patients with SUV mean ≤ the median value of the cohort, 58% vs. 82%, respectively, p = 0.03. Conclusion: Increasing SUV mean in the primary tumor was associated with inferior DFS. Although not routinely reported, pretreatment SUV mean may be a useful prognostic FDG-PET parameter and should be further evaluated prospectively.

    Original languageEnglish
    Pages (from-to)548-553
    Number of pages6
    JournalInternational Journal of Radiation Oncology Biology Physics
    Issue number2
    StatePublished - Feb 1 2012


    • FDG-PET
    • Head and neck cancer
    • SUV


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