FDG-PET Assessment of the Effect of Head and Neck Radiotherapy on Parotid Gland Glucose Metabolism

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• 作者：Michael C. Roach ; B.E.^&lowast ; ; Timothy G. Turkington ; Ph.D.^&dagger ; ; ^&Dagger ; ; Kristin A. Higgins ; M.D.^§ ; ; Thomas C. Hawk ; B.S.^&dagger ; ; Jenny K. Hoang ; MBBS.^&dagger ; ; ^§ ; ; David M. Brizel ; M.D.^§ ; ; ^¶ ; ; ^{david.brizel@duke.edu}
• 关键词：Parotid ; Head and neck cancer ; Dose&ndash ; volume effects ; PET ; IMRT
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 出版时间：1 January 2012
• 年：2012
• 卷：82
• 期：1
• 页码：321-326
• 全文大小：325 K

文摘

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Purpose

Functional imaging with [F-18]-fluorodeoxyglucose positron emission tomography (FDG-PET) provides the opportunity to define the physiology of the major salivary glands before and after radiation therapy. The goal of this retrospective study was to identify the radiation dose¨Cresponse relationship of parotid gland glucose metabolism in patients with head and neck squamous cell carcinoma (HNSCC).

Materials and Methods

Forty-nine adults with HNSCC were identified who had curative intent intensity-modulated radiation therapy (IMRT) and FDG-PET imaging before and after treatment. Using a graphical user interface, contours were delineated for the parotid glands on axial CT slices while all authors were blinded to paired PET slices. Average and maximal standard uptake values (SUV) were measured within these anatomic regions. Changes in SUV and volume after radiation therapy were correlated with parotid gland dose¨Cvolume histograms from IMRT plans.

Results

The average parotid gland volume was 30.7 mL and contracted 3.9 ¡À 1.9 % with every increase of 10 Gy in mean dose (m>pm> = 0.04). However, within the first 3 months after treatment, there was a uniform reduction of 16.5 % ¡À 7.3 % regardless of dose. The average SUV_mean of the glands was 1.63 ¡À 0.48 pretreatment and declined by 5.2 % ¡À 2.5 % for every increase of 10 Gy in mean dose (m>pm> = 0.04). The average SUV_max was 4.07 ¡À 2.85 pretreatment and decreased in a sigmoid manner with mean dose. A threshold of 32 Gy for mean dose existed, after which SUV_max declined rapidly.

Conclusion

Radiation dose responses of the parotid glands can be measured by integrated CT/FDG-PET scans. Retrospective analysis showed sigmoidal declines in the maximum metabolism but linear declines in the average metabolism of the glands with dose. Future studies should correlate this decline in FDG uptake with saliva production to improve treatment planning.