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PET in the Assessment of Therapy Response in Patients with Carcinoma of the Head and Neck and of the Esophagus*

Division of Nuclear Medicine, Department of Radiology, New York Presbyterian Hospital, Weill Medical College, Cornell University, New York, New York

View larger version (82K): [in a new window]   FIGURE 1. A 45-y-old man with invasive squamous cell carcinoma of left palatine tonsil. (A) Patient underwent 18F-FDG PET scan simultaneously with CT before initiation of therapy. Axial PET (middle) image reveals intense 18F-FDG uptake in left tonsil (vertical arrow) as well as in a left jugular lymph node (horizontal arrow), consistent with primary disease and local lymph node metastasis, respectively (locally advanced disease). Axial CT (left) and PET/CT fusion (right) images confirm these findings (arrows). Comprehensive examination was obtained by simultaneous CT and PET/CT, combining anatomic data with functional or metabolic information. (B) Same patient underwent 18F-FDG PET scan simultaneously with CT 1 mo after completion of neoadjuvant chemoradiotherapy. Axial PET (middle) and PET/CT (right) images demonstrate interval resolution of primary disease in left tonsil and metastatic disease in a left jugular lymph node, consistent with complete response to therapy. This patient subsequently underwent surgical resection and has been disease-free during follow-up period of 6 mo. Although further follow-up is necessary, 18F-FDG PET was valuable in determination of complete response to therapy. PET/CT studies were obtained on a GE Discovery LS unit—a PET/CT fusion system combining GE LightSpeed multislice CT and Advance NXi PET (GE Medical Systems).

View larger version (84K): [in a new window]   FIGURE 2. A 50-y-old man with recurrent HNSCC in a cervical lymph node underwent PET/CT imaging before and after completion of chemotherapy. (A) Pretherapy axial CT (left) and PET (right) images reveal intense radiotracer uptake in a right jugular lymph node (arrow on PET image) in the same anatomic location as lymphadenopathy seen on corresponding CT image. (B) Posttherapy axial CT (left) and PET (right) images reveal persistent 18F-FDG uptake in the corresponding locations (arrow), consistent with residual disease and therapy failure. Patient’s disease subsequently further progressed. PET/CT studies were obtained on a GE Discovery LS unit—a PET/CT fusion system combining GE LightSpeed multislice CT and Advance NXi PET (GE Medical Systems).

View larger version (85K): [in a new window]   FIGURE 3. A 62-y-old man with history of locally advanced adenocarcinoma of distal esophagus after neoadjuvant therapy, with partial response, determined by outside 18F-FDG PET study. Patient had undergone esophagectomy and gastric pull-up surgery and now was referred for 18F-FDG PET scan to evaluate disease status 6 mo after completion of neoadjuvant therapy and surgery. Coronal CT (left), PET (middle), and PET/CT (right) images demonstrate intense 18F-FDG uptake in midline in midchest, corresponding to tracheobronchial lymph nodes, consistent with metastatic disease (arrows). Patient’s disease progressed, and patient died within 3 mo after study. This study emphasizes that 18F-FDG PET after neoadjuvant therapy appears to predict prognosis with high accuracy; median survival time of nonresponders is much shorter than that of responders. Note postsurgical anatomic changes in right upper chest secondary to gastric pull-up surgery on CT image (left; arrowhead). PET/CT studies were obtained on a GE Discovery LS unit—a PET/CT fusion system combining GE LightSpeed multislice CT and Advance NXi PET (GE Medical Systems).