Change in routine PET-derived frontal metabolism is associated with worsening depressive symptoms during treatment for head and neck cancer: a longitudinal cohort study.
TL;DR
Declining relative FDG uptake in a predefined Broca-region ROI accompanied worsening depressive symptoms during HNC treatment, supporting prospective evaluation of routine PET as a potential source of psychiatric symptom-related information in patients receiving oncological care.
Abstract
Objective
Depression is common and consequential in head and neck cancer (HNC) but often remains under-recognized during treatment. Building on a cross-sectional finding, we tested whether within-patient change in 18F-FDG uptake in a left inferior frontal (Broca's) ROI accompanied depressive symptom change during HNC treatment.
Methods
Sixty-three adults underwent paired whole-body PET/CT and sixty-one completed symptom assessments. Broca's ROI was the single predefined primary region; five additional regions were exploratory comparators. Regional SUVmean was normalized to whole-brain SUVmean. Associations were assessed using Spearman correlation and adjusted regression.
Results
Over a median 5.9 months, SDS scores increased from 41.5 to 48.2 (d=0.38, p=0.004), and 28 patients (46%) screened positive at follow-up. The Broca-region ROI was the only region showing significant uptake decline after false-discovery-rate correction (SUVr 1.28 to 1.21; pFDR=0.011). Greater uptake decline accompanied greater symptom worsening (ρ=-0.34, 95% CI -0.54 to -0.09, p=0.008). Each 0.10-unit greater SUVr decline corresponded to a 4.4-point greater SDS increase (95% CI 1.8-6.9, p=0.001), with consistent sensitivity analyses.
Conclusions
Declining relative FDG uptake in a predefined Broca-region ROI accompanied worsening depressive symptoms during HNC treatment, supporting prospective evaluation of routine PET as a potential source of psychiatric symptom-related information in patients receiving oncological care.