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Impact of a second FDG PET scan before adjuvant therapy for the early detection of residual/relapsing tumours in high-risk patients with oral cavity cancer and pathological extracapsular spread

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Extracapsular spread (ECS) to the cervical lymph nodes is a major adverse prognostic factor in oral cavity squamous cell carcinoma (OSCC). We prospectively examined the value of FDG PET immediately before postoperative radiotherapy/concurrent chemoradiotherapy (pre-RT/CCRT PET) to detect residual/relapsing disease in the early postsurgical follow-up period in high-risk OSCC patients with ECS.

Methods

We examined 183 high-risk OSCC patients with ECS who underwent preoperative FDG PET/CT for staging purposes. Of these patients, 29 underwent a second pre-RT/CCRT FDG PET/CT scan. The clinical utility of the second FDG PET/CT was examined using Kaplan-Meier curve analysis.

Results

Patients who underwent the second FDG PET/CT scan had baseline clinicopathological characteristics similar to those who did not undergo a second scan. Of the patients who underwent the second scan, seven (24 %) had unexpected, newly discovered lesions. Five eventually died of the disease, and two had no evidence of recurrence after a change in RT field and dose. In an event-based analysis at 2 months, rates of neck control (6/29 vs. 6/154, p = 0.001), distant metastases (3/29 vs. 4/154, p = 0.046), and disease-free survival (7/29 vs. 10/154, p = 0.003) were significantly higher in patients who received a second PET scan than in those who did not. The second pre-RT/CCRT PET scan was of particular benefit for detecting new lesions in OSCC patients with both ECS and lymph node standardized uptake value (SUV) of ≥5.2 in the first PET scan.

Conclusion

The present findings support the clinical value of pre-RT/CCRT FDG PET for defining treatment strategy in OSCC patients with both ECS and high nodal SUV, even when FDG PET had already been performed during the initial staging work-up.

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Acknowledgments

This work was supported financially by grants CMRPG370063 and CMRPG371502 from the Chang Gung Memorial Hospital at Linkou.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China

    Chun-Ta Liao, Shiang-Fu Huang, I-How Chen & Chung-Jan Kang

  2. Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China

    Chun-Ta Liao, Kang-Hsing Fan, Chien-Yu Lin, Hung-Ming Wang, Shiang-Fu Huang, I-How Chen, Chung-Jan Kang, Shu-Hang Ng, Chuen Hsueh, Li-Yu Lee, Chih-Hung Lin & Tzu-Chen Yen

  3. Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China

    Kang-Hsing Fan & Chien-Yu Lin

  4. Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China

    Hung-Ming Wang

  5. Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China

    Shu-Hang Ng

  6. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China

    Chuen Hsueh & Li-Yu Lee

  7. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China

    Chih-Hung Lin

  8. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing St., Kwei-Shan, Taoyuan, Taiwan, Republic of China

    Tzu-Chen Yen

Authors
  1. Chun-Ta Liao
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  2. Kang-Hsing Fan
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  3. Chien-Yu Lin
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  4. Hung-Ming Wang
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  5. Shiang-Fu Huang
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  6. I-How Chen
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  7. Chung-Jan Kang
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  8. Shu-Hang Ng
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  9. Chuen Hsueh
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  10. Li-Yu Lee
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  11. Chih-Hung Lin
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  12. Tzu-Chen Yen
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Corresponding author

Correspondence to Tzu-Chen Yen.

Additional information

Drs. Chien-Yu Lin and Chun-Ta Liao contributed equally to this work.

Dr. Hung-Ming Wang co-corresponding author.

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Liao, CT., Fan, KH., Lin, CY. et al. Impact of a second FDG PET scan before adjuvant therapy for the early detection of residual/relapsing tumours in high-risk patients with oral cavity cancer and pathological extracapsular spread. Eur J Nucl Med Mol Imaging 39, 944–955 (2012). https://doi.org/10.1007/s00259-012-2103-2

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  • DOI: https://doi.org/10.1007/s00259-012-2103-2

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