Positron emission tomography changes management and improves prognostic stratification in patients with head and neck cancer: A prospective, multi-centre study

Abstract

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Objectives: The aims of this study were to: 1) examine the impact of PET in changing initial management plans in patients with untreated head and neck cancer and, 2) determine the incremental staging information provided by PET and document the effect of PET on treatment outcomes.

Methods: Patients (pts) with untreated head and neck cancer underwent 18F-Fluorodeoxyglucose (FDG) PET scans. All pts underwent comprehensive staging investigations within 6 weeks of PET scans. Pre-PET management plans were documented blinded to PET results and management plan changes due to PET scan findings were documented. Follow-up to 12 months post-treatment was performed to determine actual management and clinical outcomes.

Results: There were 71 pts (49M:22F, median age 56 yrs). PET scans resulted in management change in 24 (33.8%) pts (95% CI 22.8% - 44.8%). A high and medium management impact was seen in 13 (18.3%) and 11 (15.5%) pts respectively (χ2 = 69.8, p <.001). PET detected additional sites of disease in 28 (39.4%) pts (9 primary, 27 lymph nodes, and 7 distant metastases). Follow-up data showed that PET improved the classification of pts into curative and palliative categories. There were trends towards inferior disease-free survival and lower complete response rates in patients with additional lesions detected on PET.

Conclusions: This prospective multi-center study clearly demonstrates that PET changes management plans and provides important prognostic information in a large proportion of patients with untreated head and neck cancer. PET also detects additional sites of disease and improves classification into curative and palliative categories.