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Sistonen HJ, Ilmarinen T, Atula T, Aro K, Schildt J, Markkola A. PET-CT detection of local residual laryngeal carcinoma after definitive (chemo)radiotherapy. BMC Cancer 2023; 23:358. [PMID: 37072716 PMCID: PMC10111680 DOI: 10.1186/s12885-023-10834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Positron emission tomography and computed tomography (PET-CT) is currently recommended in evaluating the treatment response after (chemo)radiotherapy ([C]RT). In the larynx, post-treatment changes and physiological uptake make image interpretation more challenging compared to other head and neck sites. Previous research has not addressed imaging factors specifically in the larynx that would help in distinguishing the residual disease and explain the unique challenges of that anatomic area. The study cohorts are small and heterogenous. Our objective was to investigate the ability of PET-CT in diagnosing local residual laryngeal carcinoma, and to uncover imaging factors that could be used in differentiating the residual disease from post-treatment and physiological changes. In the same study cohort, we also aimed to uncover prognostic factors for local residual or recurrent disease. METHODS Our retrospective study cohort included 73 patients with T2-T4 laryngeal carcinoma undergoing (C)RT with curative intention, and post-treatment non-contrast-enhanced PET-CT at 2-6 months. Findings were compared between local residual and non-residual disease. Local residual disease was defined as a persistent tumor growth with no evidence of remission in between, confirmed by biopsy, and evident within 6 months from the end of RT. PET-CT was evaluated using a 3-step scale: negative, equivocal, and positive. RESULTS Nine (12%) had a local residual tumor and 11 (15%) developed local recurrence, based on the biopsy. The median follow-up of surviving patients was 64 months (range, 28-174). In univariate analysis, primary tumor diameter greater than 2.4 cm (median value), and vocal cord fixation were prognostic for local residual or recurrent disease. Sensitivity, specificity, PPV, and NPV were 100%, 75%, 36%, and 100%, respectively, when the equivocal interpretation was grouped with the positive interpretation. All local residuals, and 28% (18/64) non-residuals, had a primary tumor area SUVmax of over 4.0 (p < 0.001). CT showed a persistent mass at the primary tumor area in 56% of residuals, and in 23% of non-residuals (p > 0.05). By combining SUVmax>4.0 and mass, specificity improved to 91%. CONCLUSIONS NPV of post-treatment PET-CT in laryngeal carcinoma is high, but equivocal and positive results have low PPV and require further diagnostics. All local residuals had SUVmax over 4.0. The combination of SUVmax over 4.0 and mass on CT increased specificity, but the sensitivity was low.
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Affiliation(s)
- Heli J Sistonen
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland.
| | - Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Jukka Schildt
- Department of Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland
| | - Antti Markkola
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland
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Warshavsky A, Holan A, Muhanna N, Oestraicher Y, Nachalon Y, Kampel L, Nard-Carmel N, Chaushu H, Shapira U, Ungar O, Gutfeld O, Ospovat I, Oz YN, Even-Sapir E, Horowitz G. Diagnostic efficacy of positron emission computerized tomography scans in suspicious laryngeal findings postorgan preservation treatment. Head Neck 2023; 45:207-211. [PMID: 36301004 DOI: 10.1002/hed.27227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Larynx preservation protocols (LPP) for glottic primary squamous cell carcinoma has gained popularity worldwide. Direct laryngoscopy (DL) with biopsy is mandated when recurrence is suspected. The efficacy of 18Fluoro-deoxy-glucose positron emission computerized tomography (PET-CT) as alternative first-line diagnostic investigation in suspected recurrence was evaluated. METHODS A retrospective study of patients with suspicious fiber-optic findings at more than 12 weeks after LPP. Sensitivity, specificity, and the negative predictive value (NPV) of DL and PET-CT were compared. RESULTS Seventy-two patients presenting 105 cases of suspicious events were included in this study. Fifty-two events were initially investigated by DL and 53 events by PET-CT. The sensitivity of DL and PET-CT was 56.25% and 100%, respectively. The NPV was 84% for DL and 100% for PET-CT (p = 0.015). CONCLUSION Negative PET scans after LPP are highly accurate in ruling out recurrent/persistent disease and may spare the patient from negative biopsies.
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Affiliation(s)
- Anton Warshavsky
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Holan
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Oestraicher
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yuval Nachalon
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liyona Kampel
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin Nard-Carmel
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hen Chaushu
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Udi Shapira
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Ungar
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Gutfeld
- Institute of Radiotherapy, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Inna Ospovat
- Institute of Radiotherapy, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yasmin Natan Oz
- Institute of Radiotherapy, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Even-Sapir
- Institute of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Role of Repeat PET/CT Imaging in Head and Neck Cancer Following Initial Incomplete PET/CT Response to Chemoradiation. Cancers (Basel) 2021; 13:cancers13061461. [PMID: 33806792 PMCID: PMC8004876 DOI: 10.3390/cancers13061461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Following completion of chemotherapy and radiation for the treatment of head and neck cancer, a PET/CT scan is typically obtained 3 months later to assess how well the patient responded to treatment. The results of this PET/CT are often difficult to interpret because radiation can cause inflammation around the area being treated that can take months to resolve. We looked at 57 patients who had a repeat PET/CT scan performed after initial post-treatment imaging was unclear to examine whether this was helpful in determining whether these patients require further testing. Among this group, 48% of patients converted to having a complete response to treatment and none went on to develop treatment failure. Based on our findings, repeat PET/CT imaging can provide valuable information for head and neck cancer patients that can reduce the incidence of unnecessary biopsies and surgeries. Abstract Despite waiting 13 weeks to perform a PET/CT scan after completion of chemoradiation for head and neck squamous cell carcinoma (HNSCC), equivocal findings are often found that make assessing treatment response difficult. This retrospective study examines the utility of a repeat PET/CT scan in HNSCC patients following an incomplete response on initial post-treatment imaging. For this cohort of 350 patients, initial PET/CT was performed 13 weeks after completion of treatment. For select patients with an incomplete response, repeat PET/CT was performed a median of 91 days later. Primary endpoints were conversion rate to complete response (CR) and the predictive values of repeat PET/CT imaging. Of 179 patients who did not have an initial complete response, 57 (32%) received a repeat PET/CT scan. Among these patients, 26 of 57 (48%) had a CR on repeat PET/CT. In patients with CR conversion, there were no cases of disease relapse. The sensitivity, specificity, PPV, and NPV for the repeat PET/CT for locoregional disease were 100%, 59%, 42%, and 100%. Repeat PET/CT in HNSCC patients with an incomplete post-treatment scan can be valuable in obtaining diagnostic clarity. This can reduce the incidence of unnecessary biopsies and neck dissections.
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Jain TK, Singh G, Goyal S, Yadav A, Yadav D, Khunteta N, Malhotra H. Should fluorodeoxyglucose positron emission tomography/computed tomography be the first-line imaging investigation for restaging the laryngeal carcinoma patients? World J Nucl Med 2021; 20:164-171. [PMID: 34321969 PMCID: PMC8286000 DOI: 10.4103/wjnm.wjnm_95_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/26/2020] [Accepted: 11/19/2020] [Indexed: 11/09/2022] Open
Abstract
Posttreatment detection of residual/recurrence disease in the head and neck cancers is not an easy task. Treatment induces changes create difficulties in diagnosis on conventional imaging (computed tomography [CT], magnetic resonance imaging) as well as macroscopic inspection (direct laryngoscopy). Hence, we evaluate the diagnostic performance of contract-enhanced F-18 fluorodeoxyglucose positron emission tomography (FDG PET)/CT in restaging of laryngeal carcinoma Postchemotherapy-surgery and/or radiation therapy. We retrospectively analyzed patients of carcinoma larynx (n = 100) who has completed treatment and were referred for FDG PET/CT. Two reviewers performed image analysis to determine recurrence at primary site and/lymph nodes and distant metastases. Receiver operating characteristic (ROC) was used to determine the maximum standardized uptake value (SUVmax) cut off for disease detection. Histopathological examination and clinical or imaging follow-up were taken as gold standard for recurrence. One hundred laryngeal carcinoma patients with mean age of 57.2 years (range of 40–76) were included in the present study. Among the 100 patients, 96 were male and remaining 4 were female. The average interval between completion of treatment and FDG PET/CT scan was 8.5 months (minimum 6 months). Of the 100 patients, FDG PET/CT detected FDG avid lesions in 66 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of FDG PET/CT for residual/recurrence disease detection was 90.3%, 73.7%, 84.8%, 82.3%, and 84.0%, respectively (P < 0.05). In addition, in 10 patients, metachronous primaries were detected (lung-4, thyroid-2, tongue, colon, esophagus, and lymphoma-one each). On ROC curve analysis, SUVmax >6.1 had sensitivity and specificity of 80.6% and 94.7% respectively for detection of recurrent/metastatic disease. FDG PET/CT demonstrates high diagnostic accuracy for detection of residual/recurrent disease in treated laryngeal cancer patients and our findings suggest that this imaging modality should be the first-line diagnostic investigation in this cohort of patients.
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Affiliation(s)
- Tarun Kumar Jain
- Department of Nuclear Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Guman Singh
- Department of Radiation Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sumit Goyal
- Department of Radiation Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Ajay Yadav
- Department of Medical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Dinesh Yadav
- Department of Surgical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Nitin Khunteta
- Department of Surgical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Hemant Malhotra
- Department of Medical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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Routine restaging after primary non-surgical treatment of laryngeal squamous cell carcinoma-a review. Strahlenther Onkol 2020; 197:167-176. [PMID: 33216194 PMCID: PMC7892687 DOI: 10.1007/s00066-020-01706-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Purpose Treatment of patients with laryngeal squamous cell carcinoma with radiotherapy or chemoradiation is an established alternative to laryngeal surgery in many cases, but particularly for advanced tumors without cartilage invasion. Imaging modalities face the challenge of distinguishing between posttherapeutic changes and residual disease in the complex anatomic subsite of the larynx. Guidelines concerning restaging of head and neck squamous cell carcinomas (HNSCC) are presented by the National Comprehensive Cancer Network (NCCN) and other national guidelines, but clearly defined recommendations for routine restaging particularly for laryngeal cancer are lacking. Methods A systematic search was carried out in PubMed to identify studies evaluating routine restaging methods after primary non-surgical treatment of laryngeal squamous cell carcinoma from 2009 to 2020. Results Only three studies were deemed eligible, as they included at least ≥50% patients with laryngeal squamous cell carcinoma and evaluated imaging modalities to detect residual cancer. The small number of studies in our review suggest restaging with fluoro-deoxy-glucose positron-emission tomography/computed tomography (FDG PET/CT) 3 months after initial treatment, followed by direct laryngoscopy with biopsy of the lesions identified by FDG PET/CT. Conclusion Studies evaluating restaging methods after organ-preserving non-surgical treatment of laryngeal carcinoma are limited. As radiotherapy (RT), chemoradiotherapy (CRT), systemic therapy followed by RT and radioimmunotherapy are established alternatives to surgical treatment, particularly in advanced laryngeal cancers, further studies are needed to assess and compare different imaging modalities (e.g. PET/CT, MRI, CT, ultrasound) and clinical diagnostic tools (e.g., video laryngoscopy, direct laryngoscopy) to offer patients safe and efficient restaging strategies. PET or PET/CT 3 months after initial treatment followed by direct laryngoscopy with biopsy of the identified lesions has the potential to reduce the number of unnecessary laryngoscopies.
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Subramaniam N, Balasubramanian D, Sundaram PS, Murthy S, Thankappan K, Iyer S. Role of pretreatment fluorodeoxyglucose positron emission tomography quantitative parameters in prognostication of head-and-neck squamous cell carcinoma. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_253_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
In spite of the good organ preservation strategies available for locally advanced head-and-neck squamous cell carcinoma (HNSCC), failure rates have been reported to be as high as 35%–50%. There has been an increasing interest in predicting response to treatment, to aid early intervention and better outcomes. Fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) is a standard modality for posttreatment evaluation; however, it is still underutilized as a pretreatment investigative modality. Several articles have described quantitative parameters in pretreatment FDG-PET to prognosticate patients and determine the likelihood of response to treatment; however, they are still not used commonly. This article was a review of the literature available on pretreatment FDG-PET quantitative parameters and their value in predicting failure. A thorough review of literature from MEDLINE and EMBASE was performed on pretreatment quantitative parameters in HNSCC. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were reliable parameters to predict response to organ preservation therapy, disease-free survival, and overall survival. Maximum SUV (SUVmax) was an inconsistent parameter. MTV and TLG may help predict poor response to organ preservation to initiate early surgical salvage or modify therapeutic decisions to optimize clinical outcomes. Routine use may provide additional information over SUVmax alone.
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Affiliation(s)
- Narayana Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - P Shanmuga Sundaram
- Department of Nuclear Medicine, Amrita Institute of Medical Sciences, Amrita Vidya Vidyapeetham, Kochi, Kerala, Indias
| | - Samskruthi Murthy
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Tzelnick S, Bernstine H, Domachevsky L, Soudry E. Clinical Implications of Incidental Sinonasal Positive FDG Uptake on PET-CT. Otolaryngol Head Neck Surg 2019; 160:729-733. [DOI: 10.1177/0194599818821862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) has been increasingly used in the past decade. Incidental FDG-avid findings are encountered in these studies, several of which with clinical significance. However, the significance of incidental FDG-avid sinonasal findings has not been studied to date. Study Design Retrospective cohort study. Setting A single tertiary medical center. Materials and Methods The medical records were reviewed of patients with incidental sinonasal positive FDG uptake between 2007 and 2016 who referred for further otolaryngological diagnostic workup. Results A total of 26 patients were identified, all of whom underwent a diagnostic surgical procedure. Histopathology revealed chronic inflammation (n = 12, 46.1%), malignancy (n = 7, 26.9%), inverted papilloma (n = 4, 15.5%), and fungal infections (n = 3, 11.5%). A unilateral maxillary sinus with FDG uptake was documented for 16 (61.5%) patients. CT evidence of bilateral disease and mucosal or sinus wall thickening correlated with inflammatory disease. Conclusions Incidental lesions with positive FDG uptake in the sinonasal cavities are at a high risk (40%) of being neoplastic. A diagnostic biopsy is advocated in these cases.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- Department of Otolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Driessen JP, Peltenburg B, Philippens MEP, Huijbregts JE, Pameijer FA, de Bree R, Janssen LM, Terhaard CHJ. Prospective comparative study of MRI including diffusion-weighted images versus FDG PET-CT for the detection of recurrent head and neck squamous cell carcinomas after (chemo)radiotherapy. Eur J Radiol 2018; 111:62-67. [PMID: 30691667 DOI: 10.1016/j.ejrad.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/18/2018] [Accepted: 12/04/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This prospective study aims to test if MRI including diffusion weighted images can replace FDG PET-CT in the diagnosis of patients with suspicion of local recurrent head and neck squamous cell carcinomas after (chemo)radiation. METHODS Seventy-five patients suspected of local recurrence underwent a MRI and a FDG PET-CT. Qualitative assessment of the images was performed. Reference standard was the results of biopsy or the absence of a recurrence during follow up. RESULTS Seventy patients were included. Fifty percent had local recurrence. FDG PET-CT had accuracy of 71% compared to 73% for MRI. The sensitivity and specificity were 97% compared to 69% and 46% compared to 77% for FDG PET-CT and MRI respectively. CONCLUSIONS MRI showed similar diagnostic accuracy, superior specificity but inferior sensitivity compared to FDG PET-CT. Based on current results, we consider MRI including diffusion weighted sequences unable to replace FDG PET-CT as a single imaging modality when local recurrent disease of HNSCC after (C)RT is suspected.
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Affiliation(s)
- Juliette P Driessen
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Boris Peltenburg
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Julia E Huijbregts
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank A Pameijer
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luuk M Janssen
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
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Mehanna H, McConkey CC, Rahman JK, Wong WL, Smith AF, Nutting C, Hartley AG, Hall P, Hulme C, Patel DK, Zeidler SVV, Robinson M, Sanghera B, Fresco L, Dunn JA. PET-NECK: a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomography-computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer. Health Technol Assess 2017; 21:1-122. [PMID: 28409743 PMCID: PMC5410631 DOI: 10.3310/hta21170] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Planned neck dissection (ND) after radical chemoradiotherapy (CRT) for locally advanced nodal metastases in patients with head and neck squamous cell carcinoma (HNSCC) remains controversial. Thirty per cent of ND specimens show histological evidence of tumour. Consequently, a significant proportion of clinicians still practise planned ND. Fludeoxyglucose positron emission tomography (PET)-computerised tomography (CT) scanning demonstrated high negative predictive values for persistent nodal disease, providing a possible alternative paradigm to ND. Evidence is sparse and drawn mainly from retrospective single-institution studies, illustrating the need for a prospective randomised controlled trial. OBJECTIVES To determine the efficacy and cost-effectiveness of PET-CT-guided surveillance, compared with planned ND, in a multicentre, prospective, randomised setting. DESIGN A pragmatic randomised non-inferiority trial comparing PET-CT-guided watch-and-wait policy with the current planned ND policy in HNSCC patients with locally advanced nodal metastases and treated with radical CRT. Patients were randomised in a 1 : 1 ratio. Primary outcomes were overall survival (OS) and cost-effectiveness [incremental cost per incremental quality-adjusted life-year (QALY)]. Cost-effectiveness was assessed over the trial period using individual patient data, and over a lifetime horizon using a decision-analytic model. Secondary outcomes were recurrence in the neck, complication rates and quality of life. The recruitment of 560 patients was planned to detect non-inferior OS in the intervention arm with a 90% power and a type I error of 5%, with non-inferiority defined as having a hazard ratio (HR) of no higher than 1.50. An intention-to-treat analysis was performed by Cox's proportional hazards model. SETTINGS Thirty-seven head and neck cancer-treating centres (43 NHS hospitals) throughout the UK. PARTICIPANTS Patients with locally advanced nodal metastases of oropharynx, hypopharynx, larynx, oral or occult HNSCC receiving CRT and fit for ND were recruited. INTERVENTION Patients randomised to planned ND before or after CRT (control), or CRT followed by fludeoxyglucose PET-CT 10-12 weeks post CRT with ND only if PET-CT showed incomplete or equivocal response of nodal disease (intervention). Balanced by centre, planned ND timing, CRT schedule, disease site and the tumour, node, metastasis stage. RESULTS In total, 564 patients were recruited (ND arm, n = 282; and surveillance arm, n = 282; 17% N2a, 61% N2b, 18% N2c and 3% N3). Eighty-four per cent had oropharyngeal cancer. Seventy-five per cent of tested cases were p16 positive. The median time to follow-up was 36 months. The HR for OS was 0.92 [95% confidence interval (CI) 0.65 to 1.32], indicating non-inferiority. The upper limit of the non-inferiority HR margin of 1.50, which was informed by patient advisors to the project, lies at the 99.6 percentile of this estimate (p = 0.004). There were no differences in this result by p16 status. There were 54 NDs performed in the surveillance arm, with 22 surgical complications, and 221 NDs in the ND arm, with 85 complications. Quality-of-life scores were slightly better in the surveillance arm. Compared with planned ND, PET-CT surveillance produced an incremental net health benefit of 0.16 QALYs (95% CI 0.03 to 0.28 QALYs) over the trial period and 0.21 QALYs (95% CI -0.41 to 0.85 QALYs) over the modelled lifetime horizon. LIMITATIONS Pragmatic randomised controlled trial with a 36-month median follow-up. CONCLUSIONS PET-CT-guided active surveillance showed similar survival outcomes to ND but resulted in considerably fewer NDs, fewer complications and lower costs, supporting its use in routine practice. FUTURE WORK PET-CT surveillance is cost-effective in the short term, and long-term cost-effectiveness could be addressed in future work. TRIAL REGISTRATION Current Controlled Trials ISRCTN13735240. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 17. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head & Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Chris C McConkey
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Joy K Rahman
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Wai-Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Alison F Smith
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | | | | | - Peter Hall
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Dharmesh K Patel
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Lydia Fresco
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Rosko A, Birkeland A, Shuman A, Prince M, Bradford C, Wolf G, Worden F, Eisbruch A, Srinivasan A, Wong KK, Spector ME. Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer. Head Neck 2017; 39:980-987. [PMID: 28236331 DOI: 10.1002/hed.24719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 11/30/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the predictive value of positron emission tomography (PET)-CT in identifying occult nodal metastasis in clinically and radiographically N0 patients with recurrent laryngeal cancer undergoing salvage laryngectomy. METHODS Retrospective review of 46 clinically and radiographically N0 patients with recurrent laryngeal cancer who underwent a PET-CT examination before salvage laryngectomy with neck dissection from January 1, 2002, to December 31, 2014, was performed. RESULTS Two patients (16.7%) had true-positive PET-CT results, whereas 10 patients (83.3%) had false-negative scans, 1 patient (2.9%) had a false-positive result and 33 patients (97.1%) had a true-negative PET-CT. The sensitivity of PET-CT was 16.7% (95% confidence interval [CI], 3.5% to 46.0%) with a specificity of 97.1% (95% CI, 83.8% to 99.9%), positive predictive value (PPV) of 66.7% (95% CI, 20.2% to 94.4%), and negative predictive value (NPV) of 76.7% (95% CI, 62.1% to 87.0%). CONCLUSION PET-CT has poor sensitivity and NPV making PET-CT an imperfect predictor of nodal disease in recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 980-987, 2017.
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Affiliation(s)
- Andrew Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Mark Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Carol Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Gregory Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Francis Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ka Kit Wong
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
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Périé S, Hugentobler A, Susini B, Balogova S, Grahek D, Kerrou K, Montravers F, Chater PE, St Guily JL, Talbot JN. Impact of FDG-PET to detect recurrence of head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2016; 137:647-53. [PMID: 17903585 DOI: 10.1016/j.otohns.2007.05.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 04/05/2007] [Accepted: 05/24/2007] [Indexed: 11/25/2022]
Abstract
Objective Prospectively evaluate the impact of fluorodeoxy-glucose-fluorine-18 positron emission tomography (FDG-PET) in the management of recurrence of advanced head and neck squa-mous cell carcinoma during the first year after treatment. Study Design Seventy patients were followed-up every 6 to 8 weeks during the first year after initial combined curative therapy. FDG-PET, together with conventional imaging and en-doscopy were performed systematically at 1 year (group A) or prompted earlier in case of clinically suspicious recurrence (group B). The referring physician evaluated the impact of FDG-PET on the patient's management. Another clinician checked the pertinence of decisions. Results FDG-PET had a therapeutic impact in 8 of 43 group A patients and in 16 of 27 group B patients; the overall rate was 34%. This change was pertinent in 5 of 8 and 14 of 16 cases, respectively. Overall pertinence rate of decisions was 90% versus 70% without FDG-PET. Conclusions FDG-PET had a significant overall therapeutic impact; the induced decisions were either pertinent or just led to “futile” noninvasive examinations. Systematic FDG-PET had a significantly lesser impact in comparison with FDG-PET motivated by clinical suspicion.
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Affiliation(s)
- Sophie Périé
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine University Pierre et Marie Curie Paris VI and Hospital Tenon AP-HP, Paris, France.
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Clément-Colmou K, Troussier I, Bardet É, Lapeyre M. [Clinical and paraclinical follow-up after radiotherapy for head and neck cancer]. Cancer Radiother 2015; 19:597-602. [PMID: 26278985 DOI: 10.1016/j.canrad.2015.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/20/2015] [Indexed: 11/26/2022]
Abstract
Head and neck cancer management often involves heavy multimodal treatments including radiotherapy. Despite the improvement of intensity-modulated radiation therapy, acute and late toxicities remain important. After such treatment, patients have to face different potential problems, depending on the post-therapeutic delay. In this way, short-term follow-up permits to appreciate the healing of acute toxicities and response to treatment. Long-term follow-up aims to recognize second primitive tumours and distant failure, and to detect and manage late toxicities. Medical and psychosocial supportive cares are essential, even after several years of complete remission. The objective of this article is to review the modalities of short-term and long-term follow-up of patients who receive a radiotherapy for head and neck cancer.
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Affiliation(s)
- K Clément-Colmou
- Département de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France.
| | - I Troussier
- Département d'oncologie-radiothérapie, CHRU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - É Bardet
- Département de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France
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Ichpujani VK, Rao SA, Chaturvedi AK, Dewan AK, Choudhary PS. Positron Emission Tomography-Computed Tomography: A Superior and One-Stop Shop Modality for Treated Head and Neck Carcinoma Compared With Conventional Tomography. J Oral Maxillofac Surg 2014; 72:2319-32. [DOI: 10.1016/j.joms.2014.06.419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/05/2014] [Accepted: 06/08/2014] [Indexed: 11/26/2022]
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Diagnostic performance of FDG PET/CT to detect subclinical HNSCC recurrence 6 months after the end of treatment. Eur J Nucl Med Mol Imaging 2014; 42:72-8. [DOI: 10.1007/s00259-014-2889-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
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Prendes BL, Aubin-Pouliot A, Egbert N, Ryan WR. Elective Lymphadenectomy during Salvage for Locally Recurrent Head and Neck Squamous Cell Carcinoma after Radiation. Otolaryngol Head Neck Surg 2014; 151:462-7. [DOI: 10.1177/0194599814537444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This study aimed to assess the rate of occult metastases in patients with head and neck mucosal squamous cell carcinoma who have undergone therapeutic neck radiation, and then develop primary site recurrence, without clinical evidence of recurrent neck disease. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Head and neck mucosal squamous cell carcinoma patients with N+ necks treated with primary radiation who developed primary site recurrence with radiologically resolved neck lymphadenopathy, treated with salvage primary-site surgery with or without elective cervical lymphadenectomy (ECL). Main outcome measures were rate of occult nodal metastases, complication rates, and disease-free survival. Results Sixteen patients met inclusion criteria. Of 18 neck sides that underwent either ECL or observation for a mean follow-up of 26 months, 4 (22.2%) were found to have positive occult cervical metastases, all on the ipsilateral side of preradiation neck disease. Patients with advanced T-stage and/or free flap reconstruction were more likely to undergo cervical lymphadenectomy. Patients with persistent (as opposed to recurrent) primary site tumors had the highest rate of occult cervical metastases. Conclusion The risk of occult nodal metastases of 22.2%, in this study, may be too high to justify routinely omitting elective cervical lymphadenectomy in this patient population. Lymphadenectomy should especially be considered in patients with persistent tumors, with advanced recurrent T-stage, and undergoing free flap reconstruction.
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Affiliation(s)
- Brandon L. Prendes
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Annick Aubin-Pouliot
- University of California–San Francisco, School of Medicine, San Francisco, California, USA
| | - Nitin Egbert
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
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Driessen JP, van Kempen PMW, van der Heijden GJ, Philippens MEP, Pameijer FA, Stegeman I, Terhaard CHJ, Janssen LM, Grolman W. Diffusion-weighted imaging in head and neck squamous cell carcinomas: A systematic review. Head Neck 2014; 37:440-8. [DOI: 10.1002/hed.23575] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 11/17/2013] [Accepted: 12/10/2013] [Indexed: 12/24/2022] Open
Affiliation(s)
- Juliette P. Driessen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
| | - Paulina M. W. van Kempen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Geert J. van der Heijden
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Frank A. Pameijer
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
| | - Chris H. J. Terhaard
- Department of Radiotherapy; University Medical Center Utrecht; Utrecht The Netherlands
| | - Luuk M. Janssen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
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Machiels JP, Schmitz S. Management and palliative chemotherapy for metastatic or recurrent squamous cell carcinoma of the head and neck. Expert Rev Anticancer Ther 2014; 11:359-71. [DOI: 10.1586/era.10.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kostakoglu L, Fardanesh R, Posner M, Som P, Rao S, Park E, Doucette J, Stein EG, Gupta V, Misiukiewicz K, Genden E. Early detection of recurrent disease by FDG-PET/CT leads to management changes in patients with squamous cell cancer of the head and neck. Oncologist 2013; 18:1108-17. [PMID: 24037978 DOI: 10.1634/theoncologist.2013-0068] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the efficacy of surveillance high-resolution computed tomography (HRCT) and physical examination/endoscopy (PE/E) with the efficacy of fluorodeoxyglucose (FDG)-positron emission tomography (PET)/HRCT for the detection of relapse in head and neck squamous cell carcinoma (HNSCC) after primary treatment. METHODS This is a retrospective analysis of contemporaneously performed FDG-PET/HRCT, neck HRCT, and PE/E in 99 curatively treated patients with HNSCC during post-therapy surveillance to compare performance test characteristics in the detection of early recurrence or second primary cancer. RESULTS Relapse occurred in 19 of 99 patients (20%) during a median follow-up of 21 months (range: 9-52 months). Median time to first PET/HRCT was 3.5 months. The median time to radiological recurrence was 6 months (range: 2.3-32 months). FDG-PET/HRCT detected more disease recurrences or second primary cancers and did so earlier than HRCT or PE/E. The sensitivity, specificity, and positive and negative predictive values for detecting locoregional and distant recurrence or second primary cancer were 100%, 87.3%, 56.5%, and 100%, respectively, for PET/HRCT versus 61.5%, 94.9%, 66.7%, and 93.8%, respectively, for HRCT versus 23.1%, 98.7%, 75%, and 88.6%, respectively, for PE/E. In 19 patients with true positive PET/HRCT findings, a significant change in the management of disease occurred, prompting either salvage or systemic therapy. Of the 14 curatively treated patients, 11 were alive with without disease at a median follow-up of 31.5 months. CONCLUSION FDG-PET/HRCT has a high sensitivity in the early detection of relapse or second primary cancer in patients with HNSCC, with significant management implications. Given improvements in therapy and changes in HNSCC biology, appropriate modifications in current post-therapy surveillance may be required to determine effective salvage or definitive therapies.
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Optimal timing of post-treatment [18F]fluorodeoxyglucose-PET/CT for patients with head and neck malignancy. Nucl Med Commun 2013. [PMID: 23196675 DOI: 10.1097/mnm.0b013e32835bdfe3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The aims of this study were to evaluate the ability of [F]fluorodeoxyglucose (F-FDG)-PET/computed tomography (CT) to identify tumor recurrence, nodal metastases, and distant metastases for surveillance and discuss the optimal timing of F-FDG-PET/CT examination after the completion of treatment for head and neck malignancy. METHODS A total of 319 patients who underwent a post-treatment F-FDG-PET/CT examination for head and neck malignancy were studied. F-FDG-PET/CT findings were compared with the final diagnosis confirmed by histopathological examinations or clinical and radiological follow-up for at least 6 months. Patients were divided into two groups according to the presence or absence of clinical suspicion of recurrent disease. The diagnostic accuracy of F-FDG-PET/CT was analyzed for each group. Patients were also categorized according to the time interval between the completion of treatment and the post-treatment F-FDG-PET/CT examination. Differences in diagnostic accuracy due to the time interval were also evaluated. RESULTS The diagnostic accuracy of F-FDG-PET/CT was high for both groups. The overall accuracy of F-FDG-PET/CT performed within 2 months (69%) after the completion of treatment was significantly inferior to that performed after 2 months (93%). CONCLUSION F-FDG-PET should be performed immediately for patients with clinically suspected recurrent disease. In others, it should be performed at later than 2 months after the completion of the treatment.
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Zbären P, de Bree R, Takes RP, Rinaldo A, Ferlito A. Which is the most reliable diagnostic modality for detecting locally residual or recurrent laryngeal squamous cell carcinoma after (chemo)radiotherapy? Eur Arch Otorhinolaryngol 2013; 270:2787-91. [PMID: 23689805 DOI: 10.1007/s00405-013-2564-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 05/08/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Peter Zbären
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Berne, Switzerland
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Ravanelli M, Farina D, Rizzardi P, Botturi E, Prandolini P, Mangili S, Peretti G, Nicolai P, Maroldi R. MR with surface coils in the follow-up after endoscopic laser resection for glottic squamous cell carcinoma: feasibility and diagnostic accuracy. Neuroradiology 2012; 55:225-32. [PMID: 23262560 DOI: 10.1007/s00234-012-1128-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 12/03/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study focuses on the feasibility and diagnostic accuracy of MR of the larynx performed with surface coils after endoscopic laser resection (ELR) for glottic cancer. METHODS Thirty-one MR examinations of the larynx performed with surface coils on average 12 months after ELR were retrospectively reviewed. Image quality was assessed for each acquired sequence (score 1-3). All the postoperative focal lesions detected at the excision site were analysed by assessing the following: contrast/noise ratio (CNR) normalized on lateral cricoarytenoid muscle; lesion morphology (nodular/elongated) and enhancement after contrast agent administration; apparent diffusion coefficient (ADC) on diffusion-weighted sequences (DWI). RESULTS The image quality was highest for axial and coronal T2 sequences (2.39 and 2.58, respectively), and lower for the other sequences (1.66-1.72). However, in most sequences (86-100 %) the quality was considered acceptable. Among 35 focal lesions, nine were histologically proven recurrences, 26 were classified as benign focal lesions (BFL) on the basis of the subsequent follow-up. All recurrences had an intermediate T2 signal (0 < cnr0), mostly (4/5) nodular shape, intense enhancement and high ADC. The combination of T2-weighted and DWI provided the highest accuracy in the differential diagnosis between recurrences and BFL. CONCLUSION MR with surface coils is feasible and can be considered an effective tool in the follow-up after ELR for glottic cancer.
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Affiliation(s)
- Marco Ravanelli
- Department of Radiology, University of Brescia, piazzale Spedali Civili, 1, 25123 Brescia, Italy.
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Liu G, Dierks EJ, Bell RB, Bui TG, Potter BE. Post-therapeutic surveillance schedule for oral cancer: is there agreement? Oral Maxillofac Surg 2012; 16:327-340. [PMID: 22941063 DOI: 10.1007/s10006-012-0356-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/18/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Patients with oral cavity squamous cell carcinoma represent a diverse group, and the treatment these patients undergo also varies widely. Some patients undergo local excision alone while others require extensive surgery, often with adjuvant chemoradiotherapy. The post-therapeutic surveillance schedule for these patients tends to be a "one size fits all" formula for all head and neck squamous cell carcinoma patients, which has often been dictated by institutional doctrine or a senior surgeon's dogma. The post-therapeutic needs and risks of a T1 oral cancer patient treated with surgery alone differ from those of a patient with advanced laryngeal carcinoma, and the follow-up regimen should be tailored to the specific patient's risk of loco-regional recurrence, distant metastasis, and other related medical issues. RESOURCES AND MATERIALS A total of 65 papers were identified, 18 of which either focused on follow-up strategy for oral cavity squamous cell carcinoma or their tabular data allowed these cases to be extracted. Internationally recognized cancer entities were also queried. CONCLUSIONS No international consensus was achieved about the follow-up strategies. The value of post-therapeutic surveillance schedule following oral cancer treatment is generally not in dispute, although patient-initiated symptom-driven visits can be effective in identifying tumor recurrence for oral cancer patients. The range of appointment interval schemes tends to identify a progressive escalation of visit intervals such that there are more visits in the first year than in the second, and fewer yet during the third. Patients may fail to comply with their clinic visit structure. Most references agree that follow-up beyond the third year is unnecessary and may waste medical resources as well as the time of both patient and surgeon. There is no agreement as to the need for or interval of imaging studies.
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Affiliation(s)
- Guicai Liu
- Head and Neck Surgical Associates, 1849 NW Kearney, Suite #300, Portland, OR 97209, USA
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Digonnet A, Hamoir M, Andry G, Haigentz M, Takes RP, Silver CE, Hartl DM, Strojan P, Rinaldo A, de Bree R, Dietz A, Grégoire V, Paleri V, Langendijk JA, Vander Poorten V, Hinni ML, Rodrigo JP, Suárez C, Mendenhall WM, Werner JA, Genden EM, Ferlito A. Post-therapeutic surveillance strategies in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2012; 270:1569-80. [DOI: 10.1007/s00405-012-2172-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 08/15/2012] [Indexed: 12/17/2022]
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Spector ME, Chinn SB, Rosko AJ, Worden FP, Ward PD, Divi V, McLean SA, Moyer JS, Prince MEP, Wolf GT, Chepeha DB, Bradford CR. Diagnostic modalities for distant metastasis in head and neck squamous cell carcinoma: are we changing life expectancy? Laryngoscope 2012; 122:1507-11. [PMID: 22460441 DOI: 10.1002/lary.23264] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 02/02/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if the various imaging modalities for distant metastasis (DM) diagnosis alters life expectancy in head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN Retrospective. METHODS One hundred seventy patients (mean age, 59.1 years; male:female, 135:35) with HNSCC who developed DM were reviewed. The main outcome measures were the method of DM diagnosis and time from DM diagnosis to death while controlling for clinical parameters (age, gender, tobacco status, primary tumor site, initial TNM classification, number and site of DM, administration of palliative chemotherapy). RESULTS Tumor subsites were: 40 oral cavity, 75 oropharynx, 36 larynx, 10 hypopharynx, one nasopharynx, and eight unknown primary. Of the patients, 16.5% (28/170) had distant metastasis at presentation; the remaining 142 patients were diagnosed with DM at a median of 324 days from diagnosis. Although patients diagnosed with DM by positron-emission tomography (PET) scan were more likely to have multiple DM sites (P = .0001), there were no differences in life expectancy in patients who were diagnosed with or without PET scan (median, 185 vs. 165 days, P = .833). There were no differences in life expectancy based on age, gender, site of primary tumor, or number/site of DM. The use of palliative chemotherapy resulted in a significantly longer life expectancy (median, 285 vs. 70 days; P = .001). CONCLUSIONS Although a PET scan is more likely to diagnose multiple DM sites, there was no difference in life expectancy based on imaging modality. Patients who are symptomatic from their distant metastasis have a worse life expectancy, and palliative chemotherapy was able to increase life expectancy, even in patients who were symptomatic from the distant metastasis.
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Affiliation(s)
- Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Zundel MT, Michel MA, Schultz CJ, Maheshwari M, Wong SJ, Campbell BH, Massey BL, Blumin J, Wilson JF, Wang D. Comparison of Physical Examination and Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 4–6 Months After Radiotherapy to Assess Residual Head-and-Neck Cancer. Int J Radiat Oncol Biol Phys 2011; 81:e825-32. [DOI: 10.1016/j.ijrobp.2010.11.072] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/01/2010] [Accepted: 11/20/2010] [Indexed: 01/02/2023]
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Head and neck cancer as a model for advances in imaging prognosis, early assessment, and posttherapy evaluation. Cancer J 2011; 17:159-65. [PMID: 21610469 DOI: 10.1097/ppo.0b013e31821e8a09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Novel noninvasive functional imaging methods are necessary to predict therapeutic outcome and thereby improve the ability to properly select patients for treatment with both conventional and targeted therapies, to better evaluate therapeutic effectiveness during the early phases of treatment, and to enhance a priori risk assessment for treatment induced toxicity. Functional metabolic imaging typically involves pretreatment baseline magnetic resonance imaging (MRI) and/or positron emission tomographic (PET) scans and performance of subsequent scans during and/or after treatment. Imaging parameter changes are routinely attributed to the intervening therapy and clinical outcomes subsequently correlated with these changes. The physiologic parameter(s) that best correlate with clinical outcome and the relative utility of MRI versus PET are unknown, however. Furthermore, tumor vascular physiology and metabolic parameters are heterogeneous and dynamic processes. Large daily fluctuations often occur in the absence of treatment. The magnitude of this temporal variability is not established for MRI or for PET. Routine and meaningful clinical application of functional imaging requires understanding and quantification of the intrinsic variability of the underlying biologic processes and a demonstration that treatment-induced changes exceed intrinsic temporal variation.
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The role of PET/CT in the management of head and neck squamous cell carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Chu MMAY, Kositwattanarerk A, Lee DJ, Makkar JS, Genden EM, Kao J, Packer SH, Som PM, Kostakoglu L. FDG PET with contrast-enhanced CT: a critical imaging tool for laryngeal carcinoma. Radiographics 2011; 30:1353-72. [PMID: 20833855 DOI: 10.1148/rg.305095764] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has evolved to be an essential imaging modality in the evaluation of laryngeal carcinoma. Although the modality has limited utility in assessing the extent of the primary tumor, FDG PET has proved to be superior to anatomic modalities in the detection of lymph node and distant metastases. The role of FDG PET in the evaluation of patients with laryngeal tumors that are clinically classified as N0 has not shown consistent usefulness because of the innate resolution limitations of the camera. In the posttherapy setting, however, FDG PET has consistently demonstrated a high negative predictive value in the identification of recurrent disease, both during the course of therapy and during long-term follow-up. In addition, contrast material-enhanced computed tomography (CT) in conjunction with FDG PET has demonstrated a complementary role by allowing for superior anatomic coregistration and therefore more definitive diagnosis. There is sufficient evidence that with further advances in PET technology, this modality will likely become more useful in the detection of small lesions and occult nodal disease, as well as in guiding the management of laryngeal carcinoma.
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Affiliation(s)
- Mae Mae A Y Chu
- Department of Radiology, Mount Sinai Medical Center, New York, NY 10029, USA.
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Abstract
In initial staging of head and neck cancers, the addition of FDG PET to conventional imaging improves the accuracy for cervical nodal metastases. The sensitivity of FDG PET is, however, limited in nodes <1 cm and in completely necrotic nodes. In the posttherapy setting, PET scans obtained at least 10 weeks after radiotherapy have an excellent predictive value to rule out residual disease. Due to the limited positive predictive value of FDG PET after radiation therapy, a positive PET scan needs to be confirmed before management decisions are made.
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Affiliation(s)
- Yusuf Menda
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Newer imaging techniques in head and neck cancer. Indian J Surg Oncol 2010; 1:186-93. [PMID: 22930633 DOI: 10.1007/s13193-010-0031-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 02/18/2010] [Indexed: 10/25/2022] Open
Abstract
Computerized tomography (CT), Magnetic Resonance Imaging form the backbone of head and neck cancer imaging. This review describes the role of newer functional imaging techniques like diffusion weighted MR imaging and perfusion imaging in head and neck cancers. A review of the current role of PET-CT in head and neck tumors is also included in this article.
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Gupta T, Jain S, Agarwal JP, Rangarajan V, Purandare N, Ghosh-Laskar S, Dinshaw KA. Diagnostic performance of response assessment FDG-PET/CT in patients with head and neck squamous cell carcinoma treated with high-precision definitive (chemo)radiation. Radiother Oncol 2010; 97:194-9. [DOI: 10.1016/j.radonc.2010.04.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 03/17/2010] [Accepted: 04/10/2010] [Indexed: 11/16/2022]
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Role of glucose metabolism and cellularity for tumor malignancy evaluation using FDG-PET/CT and MRI. Nucl Med Commun 2010. [DOI: 10.1097/mnm.0b013e328339350c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Simons AL, Mattson DM, Dornfeld K, Spitz DR. Glucose deprivation-induced metabolic oxidative stress and cancer therapy. J Cancer Res Ther 2010; 5 Suppl 1:S2-6. [PMID: 20009288 DOI: 10.4103/0973-1482.55133] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cancer cells (vs. normal cells) demonstrate evidence of oxidative stress, increased glycolysis, and increased pentose cycle activity. The oxidative stress in cancer cells has been hypothesized to arise from mitochondrial dysfunction leading to increased levels of hydroperoxides, and cancer cells have been proposed to compensate for this defect by increasing glucose metabolism. Glucose metabolism has also been shown to play a role in hydroperoxide detoxification via the formation of pyruvate (from glycolysis) and NADPH (from the pentose cycle). Furthermore, in cancer cells, glucose deprivation as well as treatment with 2-deoxyglucose (2 DG) has been shown to induce oxidative stress and cytotoxicity. Additionally, transformed cells have been shown to be more susceptible to glucose deprivation (and 2DG-)-induced cytotoxicity and oxidative stress than untransformed cells. These results support the hypothesis that cancer cells have a defect in mitochondrial respiration leading to increased steady state levels of O2*- and H2O2, and glucose metabolism is increased to compensate for this defect. The application of these findings to developing cancer therapies using 2DG combined with inhibitors of hydroperoxide metabolism to induce radio/chemosensitization is discussed, as well as the possibility that FDG-PET imaging may predict tumor responses to these therapies.
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Affiliation(s)
- Andrean L Simons
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
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Chawla S, Kim S, Wang S, Poptani H. Diffusion-weighted imaging in head and neck cancers. Future Oncol 2009; 5:959-75. [PMID: 19792966 DOI: 10.2217/fon.09.77] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This article reviews the utility of diffusion-weighted imaging (DWI) in the diagnosis, prognosis and monitoring of treatment response in tumors arising in the head and neck region. The apparent diffusion coefficient (ADC) value, determined from DWI, can help in cancer staging and detection of subcentimeter nodal metastasis. The ADC value also discriminates carcinomas from lymphomas, benign lesions from malignant tumors and tumor necrosis from abscesses. Low pretreatment ADC values typically predict a favorable response to chemoradiation therapy. These promising reports indicate the potential of DWI as a potential biomarker for diagnosis and monitoring of treatment response in head and neck cancers. In view of the overlapping ADC values between different salivary gland tumors, care should be taken when interpreting these results and other imaging parameters should be considered for a better diagnosis. Susceptibility and motion-induced artifacts may sometimes degrade DWI image quality; however, novel techniques are being developed to overcome these drawbacks.
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Kao J, Vu HL, Genden EM, Mocherla B, Park EE, Packer S, Som PM, Kostakoglu L. The diagnostic and prognostic utility of positron emission tomography/computed tomography-based follow-up after radiotherapy for head and neck cancer. Cancer 2009; 115:4586-94. [PMID: 19544537 DOI: 10.1002/cncr.24493] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow-up program incorporating serial (18)F-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer. METHODS A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow-up, 21 months). RESULTS The sensitivity, specificity, and positive and negative predictive values of PET/CT-based follow-up for detecting locoregional recurrence were 92%, 82%, 42%, and 98%, respectively. Corresponding values for distant metastases or second primary tumors were 93%, 96%, 81%, and 98%, respectively. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2-year progression-free survival and 2-year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively). CONCLUSIONS Although post-therapy follow-up using PET/CT is reportedly associated with a high false-positive rate in the irradiated head and neck, PET/CT appears to be a highly sensitive technique for the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value.
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Affiliation(s)
- Johnny Kao
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York, USA.
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Krabbe CA, Pruim J, Dijkstra PU, Balink H, van der Laan BF, de Visscher JG, Roodenburg JL. 18F-FDG PET as a Routine Posttreatment Surveillance Tool in Oral and Oropharyngeal Squamous Cell Carcinoma: A ProspectiveStudy. J Nucl Med 2009; 50:1940-7. [DOI: 10.2967/jnumed.109.065300] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Al-Ibraheem A, Buck A, Krause BJ, Scheidhauer K, Schwaiger M. Clinical Applications of FDG PET and PET/CT in Head and Neck Cancer. JOURNAL OF ONCOLOGY 2009; 2009:208725. [PMID: 19707528 PMCID: PMC2730473 DOI: 10.1155/2009/208725] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Accepted: 06/17/2009] [Indexed: 01/26/2023]
Abstract
18F-FDG PET plays an increasing role in diagnosis and management planning of head and neck cancer. Hybrid PET/CT has promoted the field of molecular imaging in head and neck cancer. This modality is particular relevant in the head and neck region, given the complex anatomy and variable physiologic FDG uptake patterns. The vast majority of 18F-FDG PET and PET/CT applications in head and neck cancer related to head and neck squamous cell carcinoma. Clinical applications of 18F-FDG PET and PET/CT in head and neck cancer include diagnosis of distant metastases, identification of synchronous 2nd primaries, detection of carcinoma of unknown primary and detection of residual or recurrent disease. Emerging applications are precise delineation of the tumor volume for radiation treatment planning, monitoring treatment, and providing prognostic information. The clinical role of 18F-FDG PET/CT in N0 disease is limited which is in line with findings of other imaging modalities. MRI is usually used for T staging with an intense discussion concerning the preferable imaging modality for regional lymph node staging as PET/CT, MRI, and multi-slice spiral CT are all improving rapidly. Is this review, we summarize recent literature on 18F-FDG PET and PET/CT imaging of head and neck cancer.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Bernd Joachim Krause
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Klemens Scheidhauer
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
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Been LB, Hoekstra HJ, Suurmeijer AJH, Jager PL, van der Laan BFAM, Elsinga PH. [18F]FLT-PET and [18F]FDG-PET in the evaluation of radiotherapy for laryngeal cancer. Oral Oncol 2009; 45:e211-5. [PMID: 19692292 DOI: 10.1016/j.oraloncology.2009.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 11/17/2022]
Abstract
The evaluation of response to radiotherapy in patients with laryngeal cancer is a challenge because of the difficulty to differentiate between post-therapy changes and recurrent or residual tumor. Positron emission tomography is a non-invasive imaging tool that may be helpful in this differentiation. In this study, [(18)F]-fluoro-3'-deoxy-L-thymidine ([(18)F]FLT), a proliferation tracer is compared with 2-[(18)F]-fluoro-2-deoxy-D-glucose ([(18)F]FDG). Patients with primary laryngeal cancer, scheduled to undergo radiotherapy were included in this study. Patients underwent both [(18)F]FLT-PET and [(18)F]FDG-PET shortly before radiotherapy. Ten patients underwent [(18)F]FLT-PET and [(18)F]FDG-PET 2-3 months after radiotherapy. Scans were analyzed visually for areas of increased tracer uptake. The standardized uptake value (SUV) was measured as a semi-quantitative value of tracer uptake. Fourteen patients, all male, were included in this study. Both [(18)F]FLT-PET and [(18)F]FDG-PET showed increased tracer uptake in 12 out of 14 patients (86%). [(18)F]FDG uptake was significantly higher than [(18)F]FLT uptake (SUV(max): 4.5 vs. 2.4 (P=0.002); SUV(mean): 3.4 vs. 1.9 (P=0.002)). After radiotherapy, 3 patients had histologically proven residual or recurrent laryngeal cancer. [(18)F]FDG was true positive in 2 out of 3 patients, whereas [(18)F]FLT showed increased tracer uptake in only one. Of the remaining 7 patients, [(18)F]FLT was true negative in all, whereas [(18)F]FDG showed increased uptake in one (false positive). [(18)F]FLT-PET is feasible in visualizing laryngeal cancer and its evaluation of treatment. The overall uptake of this tracer is significantly lower as compared with [(18)F]FDG, but tumor to background ratios are comparable.
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Affiliation(s)
- Lukas B Been
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Wang YF, Liu RS, Chu PY, Chang FC, Tai SK, Tsai TL, Huang JL, Chang SY. Positron emission tomography in surveillance of head and neck squamous cell carcinoma after definitive chemoradiotherapy. Head Neck 2009; 31:442-51. [PMID: 19177422 DOI: 10.1002/hed.20978] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We assessed the role of (18)F-fluoro-deoxy-glucose positron emission tomography (PET) in detecting head and neck squamous cell carcinoma (HNSCC) after definitive chemoradiotherapy (CRT). METHODS A prospective study presented 80 PET before and after CRT for 44 patients, including 44 first-time post-CRT scans performed between 12 and 17 weeks after radiotherapy completion, as well as 10 repeated scans in the subsequent follow-up. PET interpretations were compared with clinicopathologic outcomes. RESULTS PET demonstrated better performance than CT in post-CRT surveillance. Considering all 54 post-CRT PET scans, sensitivity for detecting primary tumors was 100%, specificity 93%, positive predictive value (PPV) 80%, and negative predictive value (NPV) 100%. For cervical diseases, sensitivity was 100%, specificity 98%, PPV 92%, and NPV 100%. For distant metastases, sensitivity was 100%, specificity 98%, PPV 86%, and NPV 100%. CONCLUSIONS Negative PET readings were reliable for predicting free of HNSCC and helpful for selected patients in post-CRT surveillance.
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Affiliation(s)
- Yi-Fen Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.
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Nemec SF, Krestan CR, Noebauer-Huhmann IM, Formanek M, Frühwald J, Peloschek P, Kainberger F, Czerny C. [Radiological normal anatomy of the larynx and pharynx and imaging techniques]. Radiologe 2009; 49:8-16. [PMID: 19023558 DOI: 10.1007/s00117-008-1761-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The larynx and the pharynx represent anatomically as well as functionally a very complex organ which serves as an airway and a nutrition channel. Knowledge of anatomy and anatomical topography is therefore a fundamental basis for the evaluation of any pathological process. Beside the clinical examination and endoscopy performed by ear, nose and throat specialists, imaging techniques play a crucial role in pre-therapeutic and post-therapeutic diagnostics. The radiologist employs a conventional x-ray swallow examination, as well as contrast-enhanced multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), positron emission tomography (PET) and positron emission tomography-computed tomography (PET-CT), depending on the medical problem in question. The following article demonstrates the functional and especially the structural anatomy of the larynx and the pharynx. Furthermore, the broad range of imaging techniques in clinical use is discussed.
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Affiliation(s)
- S F Nemec
- Klinische Abteilung für Neuroradiologie und muskuloskelettale Radiologie, Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090, Wien, Osterreich.
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Abstract
OBJECTIVES/HYPOTHESIS To determine the diagnostic accuracy and the ideal timing of fluoro-fluorodeoxyglucose positron-emission tomography (PET) in the posttreatment surveillance of head and neck mucosal squamous cell carcinoma (HNSCC). STUDY DESIGN Retrospective chart review. METHODS Our sample includes 103 adult patients with 118 posttreatment PET scans who had undergone treatment for HNSCC. We correlated PET results with surgical pathology and clinical outcome in the subsequent 6 months. RESULTS For the detection of locoregional persistent or recurrent HNSCC, PET scans had a sensitivity of 82%, specificity of 92%, positive predictive value (PPV) of 64%, negative predictive value (NPV) of 97%, and overall accuracy of 90%. For the detection of distant metastases, PET scans had a sensitivity of 89%, specificity of 97%, PPV of 85%, NPV of 98%, and overall accuracy of 96%. PET scans of the head and neck region performed greater than 1 month after the completion of radiation compared with scans performed within 1 month had a significantly higher sensitivity of 95% versus 55% (P < .01) and NPV of 99% versus 90% (P < .01). CONCLUSION PET is effective in detecting distant metastases in the posttreatment surveillance for HNSCC patients. A negative PET is highly reliable for all sites. However, a positive PET in the head and neck region is unreliable because of a high false-positivity rate. PET of the head and neck region has a statistically significant risk of a false-negative reading when performed within 1 month of radiation.
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Affiliation(s)
- William R Ryan
- Department of Otolaryngology--Head and Neck Surgery, Stanford University School of Medicine, Stanford, California 94305, USA.
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Abgral R, Querellou S, Potard G, Le Roux PY, Le Duc-Pennec A, Marianovski R, Pradier O, Bizais Y, Kraeber-Bodéré F, Salaun PY. 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? J Nucl Med 2008; 50:24-9. [PMID: 19091901 DOI: 10.2967/jnumed.108.055806] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Posttreatment surveillance for the recurrence of head and neck squamous cell carcinoma (HNSCC) is a diagnostic challenge. Tissue distortion from radiation and surgery can obscure early detection of recurrence by conventional follow-up approaches such as physical examination, CT, and MRI. Several studies have shown that 18F-FDG PET may be an effective technique for the detection of persistent, recurrent, and distant metastatic HNSCC after treatment. The aim of this prospective study was to determine the benefits of hybrid 18F-FDG PET/CT in detecting a subclinical locoregional recurrence of HNSCC and distant metastases. The study patients were considered cured of HNSCC on the basis of 12 mo of negative findings on conventional follow-up. We also assessed the diagnostic accuracy of 18F-FDG PET/CT in these patients. METHODS Ninety-one patients cured of HNSCC without any clinical evidence of recurrence were included. Whole-body 18F-FDG PET/CT examination was performed 11.6+/-4.4 mo after the end of the treatment. The gold standard was histopathology or 6 mo of imaging follow-up. RESULTS The whole-body 18F-FDG PET/CT examinations had negative results in 52 patients and positive results in 39. Nine of these patients who exhibited abnormal 18F-FDG uptake in the head and neck area did not have recurrent HNSCC (false-positive). Thirty had proven recurrence. The sensitivity and specificity of 18F-FDG PET/CT in this study for the diagnosis of HNSCC recurrence were 100% (30/30) and 85% (52/61), respectively. The positive predictive value was 77% (30/39). The negative predictive value was 100% (52/52). The overall accuracy was 90% (82/91). CONCLUSION The results of our study confirm the high effectiveness of 18F-FDG PET/CT in the assessment of HNSCC recurrence and suggest that 18F-FDG PET/CT is more accurate than conventional follow-up physical examination alone in the assessment of recurrence after previous curative treatment for HNSCC and could be proposed systematically at 12 mo of the usual follow-up.
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Affiliation(s)
- Ronan Abgral
- Nuclear Medicine Department, University Hospital of Brest, Brest, France
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van Hooren ACG, Brouwer J, de Bree R, Hoekstra OS, Leemans CR, Uyl-de Groot CA. The cost-effectiveness of 18FDG-PET in selecting patients with suspicion of recurrent laryngeal carcinoma after radiotherapy for direct laryngoscopy. Eur Arch Otorhinolaryngol 2008; 266:1441-8. [PMID: 19043728 PMCID: PMC2718190 DOI: 10.1007/s00405-008-0878-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 11/11/2008] [Indexed: 01/14/2023]
Abstract
The aim of this study was to estimate the cost-effectiveness of 18FDG-PET in the selection for direct laryngoscopy in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. The direct medical costs of 30 patients with suspicion of a recurrence were calculated from the first visit where suspicion was raised until one year after. A conventional strategy, in which all these patients underwent direct laryngoscopy, was compared to an 18FDG-PET strategy in which only patients with a positive or equivocal 18FDG-PET underwent direct laryngoscopy. A sensitivity analysis was performed to examine the influence of the type of camera and ‘setting’. The mean costs of an 18FDG-PET strategy were €399 less than a direct laryngoscopy strategy. The type of camera and setting had no influence. In patients with suspicion for recurrent laryngeal carcinoma after radiotherapy, 18FDG-PET seems to be effective and less costly in selecting patients for direct laryngoscopy.
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Abstract
Treatment of laryngeal cancer has evolved, and newer methods of laryngeal conservation, both surgical and nonsurgical, are the primary treatment of choice. Nevertheless, total laryngectomy is not extinct and still plays an important role in primary therapy for advanced stage laryngeal cancers and as salvage therapy for failures of organ preservation strategies.
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Affiliation(s)
- Nishant Agrawal
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, JHOC 6th Floor, Baltimore, MD 21287, USA
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Prospective comparison of FDG and FET PET/CT in patients with head and neck squamous cell carcinoma. Mol Imaging Biol 2008; 10:364-73. [PMID: 18668293 DOI: 10.1007/s11307-008-0155-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 03/27/2008] [Accepted: 04/01/2008] [Indexed: 10/21/2022]
Abstract
AIM The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC. MATERIALS AND METHODS Twenty-seven patients (20 men and seven women, aged 48-76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings. RESULTS Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p<0.02) and specificity with FET (p<0.01). The statistical level of significance was not reached at patient level. CONCLUSION Although its good specificity was confirmed, FET did not appear to be suited as a first-line PET tracer in HNSCC imaging and cannot replace FDG for staging due to insufficient sensitivity. However, it was useful in a few selected cases to favor a wait and see attitude when a FDG+ FET- focus was discovered in patients referred for systematic FDG PET during follow-up. In contrast, second primary cancers should not be ruled out if FDG was clearly positive in the lungs or the digestive tract.
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2-Deoxy-2[F-18]FDG-PET for detection of recurrent laryngeal carcinoma after radiotherapy: interobserver variability in reporting. Mol Imaging Biol 2008; 10:294-303. [PMID: 18622649 PMCID: PMC2516189 DOI: 10.1007/s11307-008-0154-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 03/22/2008] [Accepted: 03/26/2008] [Indexed: 10/29/2022]
Abstract
PURPOSE To evaluate accuracy and interobserver variability in the assessment of 2-deoxy-2[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) for detection of recurrent laryngeal carcinoma after radiotherapy. PROCEDURES Eleven experienced nuclear physicians from eight centres assessed 30 FDG-PET scans on the appearance of local recurrence (negative/equivocal/positive). Conservative (equivocal analysed as negative) and sensitive (equivocal analysed as positive) assessment strategies were compared to the reference standard (recurrence within 6months after PET). RESULTS Seven patients had proven recurrences. For the conservative and sensitive strategy, the mean sensitivity was 87% and 97%, specificity 81% and 63%, positive predictive values 61% and 46% and negative predictive values 96% and 99%, respectively. Interobserver variability showed a reasonable relation in comparison to the reference standard (kappa = 0.55). CONCLUSIONS FDG-PET has acceptable interobserver agreement and yields good negative predictive value for detection of recurrent laryngeal carcinoma. It could therefore be used as first diagnostic step and may reduce futile invasive diagnostics.
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Higashiyama S, Kawabe J, Hayashi T, Kurooka H, Oe A, Kotani J, Kawamura E, Shiomi S. A case of cavernous hemangioma in which malignancy was preoperatively excluded by FDG-PET. Ann Nucl Med 2008; 22:327-30. [DOI: 10.1007/s12149-007-0101-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 12/02/2007] [Indexed: 10/22/2022]
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