ArticleFrontiers in oncology2026
Prognostic significance of intermediate and high SUVmax values and imaging timing on FDG-PET/CT after radiation therapy in HNSCC: a retrospective cohort study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Head and neck cancer is a disease with a tendency for recurrence and metastases even after treatment. Late detection leads to poor patient outcomes. One promising diagnostic tool is FDG-PET/CT which can detect both, morphological and metabolic evidence of malignant diseases. A common measure is SUVmax, the maximum standardized uptake value in a lesion. The objective of this study is to evaluate the prognostic value of post-treatment FDG-PET/CT in patients with head and neck squamous cell carcinoma (HNSCC), focusing on the association of SUVmax and scan timing with progression-free survival (PFS). Methods: This retrospective study included 84 patients with HNSCC treated with definitive radiotherapy between 2016 and 2023 at a German university hospital. All patients underwent at least one post-radiotherapy FDG-PET/CT scan. All post radiation scans that were performed before or no later than one month after documented disease progression were included for prognostic analysis. SUVmax values were categorized into three groups: (1) physiological uptake (no suspicious lesion, no SUVmax value recorded, and radiological report consistent with post-therapeutic changes), (2) intermediate uptake (SUVmax >1 but <7.5), and (3) high uptake (SUVmax ≥7.5). PET/CT timing was stratified as early (≤3 months) or delayed (>3 months) after radiotherapy. Diagnostic performance metrics and survival outcomes were analyzed. Results: A total of 88 post-treatment PET/CT scans were evaluated. Mean follow up was 27.7 months. Disease progression occurred in 33 patients and 10 patients died during follow-up. SUVmax ≥7.5 was significantly associated with shorter PFS (p < 0.05). Intermediate SUVmax values also predicted increased progression risk compared to physiological uptake. The optimal diagnostic performance was achieved with delayed PET/CT (>3 months), particularly using a low SUVmax threshold (>1), which yielded high sensitivity (90.9%) and negative predictive value (88.9%). Multivariate analysis confirmed SUVmax as an independent predictor of PFS (HR: 1.21; 95% CI: 1.11-1.32; p < 0.001), alongside male sex and oral cavity primary site. Conclusion: Post-treatment FDG-PET/CT is a valuable prognostic tool in HNSCC follow-up. SUVmax, especially when evaluated after three months, is predictive of disease progression. Integrating PET/CT into routine surveillance may improve risk stratification and inform tailored follow-up intensity.
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