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¹⁸F-FDG PET as a Routine Posttreatment Surveillance Tool in Oral and Oropharyngeal Squamous Cell Carcinoma: A ProspectiveStudy

¹ Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands; ² Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands; ³ Center for Rehabilitation, University Medical Center, Groningen, Groningen, The Netherlands; ⁴ School for Health Research, University Medical Center, Groningen, Groningen, The Netherlands; ⁵ Department of Nuclear Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands; ⁶ Department Otorhinolaryngology, University Medical Center Groningen, Groningen, The Netherlands; and ⁷ Department of Oral and Maxillofacial Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands

Correspondence: For correspondence or reprints contact: Christiaan A. Krabbe, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. E-mail: c.a.krabbe{at}kchir.umcg.nl

The purpose of this study was to evaluate the role and timing of serial ¹⁸F-FDG PET scans as routine surveillance for detecting early locoregional recurrence, distant metastases, and second primary tumors in patients treated for advanced squamous cell carcinoma (SCC) in the oral cavity or oropharynx during the first year after completion of their curative treatment. Methods: Forty-eight consecutive patients with SCC in the oral cavity or oropharynx were included after completing their initial therapy with curative intent. Prospective follow-up of the participants was 2-fold: regular follow-up (history and physical examination) and serial ¹⁸F-FDG PET scans. Patients underwent standard follow-up and ¹⁸F-FDG PET at 3, 6, 9, and 12 mo after initial treatment. Findings were validated by histopathology or 18 mo of clinical follow-up and imaging after initial treatment. Results: Incidence of recurrences and second primary tumors was 27% and 10%, respectively. ¹⁸F-FDG PET was significantly (P = 0.035) more often in agreement with the gold standard than was regular follow-up. ¹⁸F-FDG PET showed a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 43%, 51%, and 100%, respectively. For regular follow-up, these values were 0%, 60%, 0%, and 50%, respectively. ¹⁸F-FDG PET accounted for a change in diagnostics or treatment in 63% of the patients and regular follow-up in 25% of the patients. Sensitivity and specificity of ¹⁸F-FDG PET were both irrespective of timing of ¹⁸F-FDG PET. For the 3- and 6-mo posttherapy results combined, ¹⁸F-FDG PET detected malignancy in 16 of the 18 patients. Conclusion: ¹⁸F-FDG PET is a suitable routine posttreatment surveillance tool in oral and oropharyngeal SCC patients and detects malignancy before clinical suggestion by the regular follow-up arises. The best timing of a systematic ¹⁸F-FDG PET scan is between 3 and 6 mo after treatment.

Key Words: positron emission tomography • squamous cell carcinoma • head and neck cancer • fluorodeoxyglucose • recurrence

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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				N. C. Nguyen, P. Fajnwak, M. M. Osman, and H. R. Farghaly 18F-FDG PET for Routine Posttreatment Surveillance in Oral and Oropharyngeal Squamous Cell Carcinoma J. Nucl. Med., July 1, 2010; 51(7): 1164 - 1164. [Full Text] [PDF]

				C. A. Krabbe, J. Pruim, P. U. Dijkstra, and J. L. N. Roodenburg Reply: 18F-FDG PET for Routine Posttreatment Surveillance in Oral and Oropharyngeal Squamous Cell Carcinoma J. Nucl. Med., July 1, 2010; 51(7): 1164 - 1165. [Full Text] [PDF]