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Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy

Modifikation von Staging und Therapie bei Kopf-Hals-Tumoren durch FDG-PET/CT vor Bestrahlung

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Abstract

Background and purpose

Reliable tumor staging is a fundamental pre-requisite for efficient tumor therapy and further prognosis. The aim of this study was to compare head and neck cancer (HNC) staging before and after FDG-PET/CT, evaluating the stage modifications for radiotherapy (RT) planning.

Patients and methods

A total of 102 patients with untreated primary HNC, who underwent conventional staging and staging including FDG-PET/CT before RT, were enrolled in this retrospective study. Blinded pre-FDG-PET/CT and post-FDG-PET/CT staging data were compared. The impact on patient management was tested by comparing the intention before and after FDG-PET/CT.

Results

Significant modifications of T, N, and M stage as well as clinical stage were detected after inclusion of FDG-PET/CT data (p = 0.002, 0.0006, 0.001, 0.03, respectively). Overall, the implementation of FDG-PET/CT led to modification of RT intention decision in 14 patients.

Conclusions

FDG-PET/CT demonstrates essential influence on tumor staging in HNC patients scheduled for irradiation. Implementation of FDG-PET/CT in imaging protocol improves selection of candidates for curative and palliative RT and allows further optimization of treatment management and therapy intention.

Zusammenfassung

Hintergrund und Ziel

Ein zuverlässiges Staging ist ausschlaggebend für eine optimale Tumortherapie und die weitere Prognose. Die Studie sollte klären, ob die Einbeziehung der FDG-PET/CT in die Diagnostik von Patienten mit Kopf-Hals-Tumoren (KHT) vor Strahlentherapie das TNM-, das klinische Staging und die Therapieintention im Vergleich zum konventionellen Staging verändert.

Patienten und Methoden

102 konsekutive Patienten mit unbehandelten Kopf-Hals-Tumoren (KHT) erhielten nach dem klinischen Standardstaging, anhand dessen eine Strahlentherapie geplant worden wäre, ergänzend eine FDG-PET/CT. Es wurden die Staging-Daten vor und nach FDG-PET/CT verglichen und der Einfluss auf das Patientenmanagement durch den Vergleich der Therapieplanung vor und nach FDG-PET/CT untersucht.

Ergebnisse

Die Berücksichtigung der FDG-PET/CT-Daten führte zur einer signifikanten Änderung der T-, N-, M-Stadien (p = 0,002; 0,0006; 0,001) sowie des klinischen Stadiums (p=0,03). Insgesamt wurde bei 14 Patienten eine Modifikation der Strahlentherapieintention festgestellt.

Schlussfolgerungen

Der Einsatz der FDG-PET/CT bei Patienten mit Kopf-Hals-Tumoren vor Strahlentherapie ermöglicht eine verfeinerte Auswahl der Kandidaten für kurative und palliative Bestrahlung und führt im Vergleich zum konventionellen Staging zu einer verbesserten Therapieentscheidung.

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Acknowledgment

The authors and this work were supported by the German Federal Ministry of Education and Research, Germany, BMBF Contract 03ZIK042 and by the ERDF European Regional Development Fund, project “Gemeinsames Zentrum für Strahlenforschung in der Onkologie,” project number 100066308.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. OncoRay – National Center for Radiation Research in Oncology, Biological and Molecular Imaging, Medical Faculty and University Hospital Carl Gustav Carus, Dresden, Germany

    A. Abramyuk, M. Baumann & N. Abolmaali

  2. Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden, Germany

    S. Appold & M. Baumann

  3. Clinic and Policlinic for Nuclear Medicine, Medical Faculty and University Hospital Carl Gustav Carus, Dresden, Germany

    K. Zöphel

  4. Institute and Policlinic of Diagnostic Radiology, Department of Neuroradiology, Medical Faculty and University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany

    A. Abramyuk

  5. Institute and Policlinic of Diagnostic Radiology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden, Germany

    N. Abolmaali

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  1. A. Abramyuk
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  2. S. Appold
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  3. K. Zöphel
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  4. M. Baumann
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  5. N. Abolmaali
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Corresponding author

Correspondence to A. Abramyuk.

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Abramyuk, A., Appold, S., Zöphel, K. et al. Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy. Strahlenther Onkol 189, 197–201 (2013). https://doi.org/10.1007/s00066-012-0283-0

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  • DOI: https://doi.org/10.1007/s00066-012-0283-0

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