Diagnostic performance of response assessment FDG-PET/CT in patients with head and neck squamous cell carcinoma treated with high-precision definitive (chemo)radiation.

PURPOSE To prospectively assess diagnostic performance of response assessment fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with HNSCC treated with high-precision definitive (chemo)radiation. METHODS Fifty-seven patients treated on a prospective clinical trial having post-treatment response assessment FDG-PET/CT scans were included. Clinico-pathologic findings and follow-up information was considered as reference standard. RESULTS First response assessment FDG-PET/CT was done at a median of 9 weeks (inter-quartile range 8-10 weeks) from completion of treatment. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of first response assessment FDG-PET/CT for identifying residual disease at primary site was 50%, 91.8%, 50%, 91.8%, and 86%. The corresponding figures for the neck were 62.5%, 98%, 83.3%, 94.1%, and 93%. With a median follow-up of 26 months (range 7-45 months), the 3-year loco-regional control (83.9% vs 58.3%, p=0.001) and overall survival (68.8% vs 58.3%, p=0.063) was significantly better in patients with negative response assessment scans. CONCLUSION The overall diagnostic accuracy of response assessment FDG-PET/CT is good, but its sensitivity and PPV is somewhat low, particularly for primary site. A negative response assessment FDG-PET/CT scan is highly suggestive of absence of viable disease that could be used to guide decision-making.

[1]  J. Bourhis,et al.  Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data , 2000, The Lancet.

[2]  C. McConkey,et al.  A systematic review and meta‐analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy , 2008, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[3]  B. S. Yurrita,et al.  [Systematic review and meta-analysis of diagnostic accuracy of 18F-FDG PET in suspected recurrent head and neck cancer]. , 2008 .

[4]  Françoise Kraeber-Bodéré,et al.  Does 18F-FDG PET/CT Improve the Detection of Posttreatment Recurrence of Head and Neck Squamous Cell Carcinoma in Patients Negative for Disease on Clinical Follow-up? , 2008, Journal of Nuclear Medicine.

[5]  L. Dawson,et al.  Recurrences near base of skull after IMRT for head-and-neck cancer: implications for target delineation in high neck and for parotid gland sparing. , 2004, International journal of radiation oncology, biology, physics.

[6]  P. V. van Rijk,et al.  F‐18‐fluoro‐deoxy‐glucose positron‐emission tomography scanning in detection of local recurrence after radiotherapy for laryngeal/ pharyngeal cancer , 2001, Head & neck.

[7]  D. Mercante,et al.  Positron emission tomography–computed tomography surveillance for the node‐positive neck after chemoradiotherapy , 2009, The Laryngoscope.

[8]  A. Balm,et al.  Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life , 2008, Radiation oncology.

[9]  L. Dawson,et al.  Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. , 2003, International journal of radiation oncology, biology, physics.

[10]  E. Genden,et al.  The diagnostic and prognostic utility of positron emission tomography/computed tomography‐based follow‐up after radiotherapy for head and neck cancer , 2009, Cancer.

[11]  C. O'brien,et al.  Accuracy of positron emission tomography in the evaluation of patients treated with chemoradiotherapy for mucosal head and neck cancer , 2009, Head & neck.

[12]  R. D'Agostino,et al.  Serial positron emission tomography scans following radiation therapy of patients with head and neck cancer , 2001, Head & neck.

[13]  L. Rybicki,et al.  Ability of positron emission tomography to detect residual neck node disease in patients with head and neck squamous cell carcinoma after definitive chemoradiotherapy. , 2007, Archives of otolaryngology--head & neck surgery.

[14]  Seong Soo Shin,et al.  The Feasibility of 18F-FDG PET scans 1 month after completing radiotherapy of squamous cell carcinoma of the head and neck. , 2007, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[15]  P. Xia,et al.  Intensity-modulated radiation therapy for head-and-neck cancer: the UCSF experience focusing on target volume delineation. , 2003, International journal of radiation oncology, biology, physics.

[16]  R. Coleman,et al.  Recommendations on the Use of 18F-FDG PET in Oncology , 2008, Journal of Nuclear Medicine.

[17]  L. Dawson,et al.  Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. , 2001, International journal of radiation oncology, biology, physics.

[18]  Jeong Hyun Lee,et al.  F-18 FDG-PET as a routine surveillance tool for the detection of recurrent head and neck squamous cell carcinoma. , 2007, Oral Oncology.

[19]  W. Bautz,et al.  Head and neck tumors: imaging recurrent tumor and post-therapeutic changes with CT and MRI. , 2000, European journal of radiology.

[20]  J. Pignon,et al.  Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. , 2009, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[21]  T. Taguchi,et al.  Early assessment of clinical response to concurrent chemoradiotherapy in head and neck carcinoma using fluoro-2-deoxy-d-glucose positron emission tomography. , 2008, Auris, nasus, larynx.

[22]  R. Hermans.  Ci Focus On: Treatment Planning Head and Neck Cancer: How Imaging Predicts Treatment Outcome , 2022 .

[23]  R. Hermans.  Posttreatment imaging in head and neck cancer. , 2008, European journal of radiology.

[24]  J. Buatti,et al.  Is planned neck dissection necessary for head and neck cancer after intensity-modulated radiotherapy? , 2007, International journal of radiation oncology, biology, physics.

[25]  I. Bradbury,et al.  Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers. , 2007, Health technology assessment.

[26]  J. Buatti,et al.  The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment. , 2005, International journal of radiation oncology, biology, physics.

[27]  L. Weih,et al.  Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo)radiotherapy in head and neck cancer , 2005, Head & neck.

[28]  J. Buatti,et al.  Clinical significance of postradiotherapy [18F]-fluorodeoxyglucose positron emission tomography imaging in management of head-and-neck cancer-a long-term outcome report. , 2009, International journal of radiation oncology, biology, physics.

[29]  V. Lowe,et al.  Squamous Cell Carcinoma: Restaging and Response to Therapy. , 2007, PET clinics.

[30]  A. Garden,et al.  Prospective risk-adjusted [18F]Fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  Mithat Gonen,et al.  Diagnostic and Prognostic Value of [18F]Fluorodeoxyglucose Positron Emission Tomography for Recurrent Head and Neck Squamous Cell Carcinoma , 2002 .

[32]  Nancy Lee,et al.  PET Monitoring of Therapy Response in Head and Neck Squamous Cell Carcinoma , 2009, Journal of Nuclear Medicine.

[33]  S. Larson,et al.  Clinical Utility of 18F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer , 2008, Journal of Nuclear Medicine.

[34]  L. Peters,et al.  The role of PET-CT in the management of patients with advanced cancer of the head and neck , 2008, Current oncology reports.