F-18 FDG-PET as a routine surveillance tool for the detection of recurrent head and neck squamous cell carcinoma

doi:10.1016/j.oraloncology.2006.08.006

Oral Oncology

Volume 43, Issue 7, August 2007, Pages 686-692

https://doi.org/10.1016/j.oraloncology.2006.08.006 Get rights and content

Summary

In order to determine the efficacy and proper timing of routine PET scans for surveillance of recurrent head and neck squamous cell carcinoma (HNSCC), we evaluated the diagnostic performance of routine PET scans in relation to time interval from completion of treatment. Amongst 206 retrospectively evaluated post-treatment PET scans of 159 patients with HNSCC, 156 were performed for routine surveillance in subclinical cases. Diagnostic performance of PET scan and follow-up outcome were evaluated in relation to the time interval (2–6 months, 6–12 months, 12–24 months, and >24 months) of PET scan from the completion of treatment. Overall sensitivity and NPV of these PET scans for recurrence were 92.5% and 94.8%, compared with 55.0% and 76.9% for conventional evaluation methods. In the 156 routine scans, the diagnostic sensitivity, specificity, and NPV for locoregional recurrence were 90%, 91% and 97%, respectively, and the values for distant metastases and second primary cancers were 100%, 97% and 100%, respectively. The diagnostic accuracy of routine PET scans was not significantly altered by the time interval. Most (97%) of true negative cases on routine PET scans had no recurrence during a median 14 months follow-up. PET scan may be a useful tool in routine surveillance for detection of recurrence in subclinical patients. For routine surveillance, the initial PET scan should be performed within 6 months after completion of treatment and the proper timing of next routine PET scan for subclinical patient with initial negative PET result might be 1 year after initial PET scan.

Introduction

The successful salvage treatment of head and neck squamous cell carcinoma (HNSCC) patients requires earlier and more accurate detection of recurrence. During the first year after treatment, many physicians perform monthly follow-up examinations, including physical examinations and structural imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). Due to anatomical changes induced by therapy, which may be further obscured by flap reconstruction, however, this method has been found to be too equivocal in detecting recurrence.1, 2, 3, 4, 5, 6

Positron emission tomography (PET) with 2-[F-18] fluoro-2-dexoy-d-glucose (FDG) is an imaging modality based on tissue metabolism rather than anatomic constructs to detect tumors. After Minn et al.⁷ showed that FDG-PET could differentiate responder to radiation therapy from non-responder, use of FDG-PET scans has grown rapidly in oncology and in the assessment of HNSCC.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16

Several reports have shown that PET scan is a useful tool to distinguish recurrent tumors from post-treatment changes. Populations of these studies, however, were mainly patients with clinically suspicion for recurrence2, 3, 4, 5 and/or prospective cohorts with PET scan at fixed time intervals within 12 months after the end of treatment.8, 9, 10, 11 Additionally, few systematic follow-up studies testing the use of routine PET scans relative to time interval, especially long term interval, have been studied for subclinical patients with no evidence of recurrence. Thus, to our knowledge, there is no consensus regarding the interval and frequency of PET scans for surveillance of recurrence of HNSCC in subclinical patients after treatment. We therefore retrospectively evaluated the accuracy and predictive value of routine PET scans relative to time interval after completion of treatment, in order to evaluate their efficacy and proper timing for surveillance of recurrent HNSCC in subclinical patients.

Section snippets

Subjects

From January 2001 to December 2004, 422 patients with HNSCC were admitted and underwent treatment in our institution. A review of these patients showed that PET scans were performed in 189 patients after completion of treatment to detect residual cancer or recurrence. We excluded 12 patients with inadequate clinical follow-up or metastatic work-up, as well as 18 patients who underwent PET scans to determine their therapeutic responses within 2 months after completion of radiation- or

Overall accuracy and predictive value

Of total 206 events with PET scan, 80 (38.8%) were locoregional recurrence and/or distant metastasis/secondary malignancy. The diagnostic accuracy of conventional evaluations and PET scans are summarized in Table 3. The overall sensitivity and negative predictive value of PET scans for the diagnosis of recurrence were 92.5% and 94.8%, respectively. In contrast, those of conventional methods were only 55.0% and 76.9%, respectively. The overall diagnostic sensitivity, negative predictive value,

Discussion

Our study showed FDG-PET was more sensitive and accurate in detecting recurrent HNSCC than conventional evaluation methods. Patients with recurrent HNSCC who undergo salvage surgery at early stages have a 70% 2-year relapse-free survival (RFS) rate, whereas those with recurrent, advanced-stage HNSCC have just a 22% 2-year RFS rate after salvage surgery.⁶ Thus, the earlier and more accurate detection of recurrent HNSCC is critically important for achieving successful salvage treatment. Our

Conclusions

With its high sensitivity and negative predictive value, PET scan may be a useful tool for routine surveillance for detection of recurrence of HNSCC in subclinical patients. For routine surveillance, the initial PET scan should be performed within 6 months after completion of treatment and the proper timing of next routine PET scan for subclinical patient with initial negative PET result might be 1 year after initial PET scan.

Disclosures

The authors have no disclosures to report.

Acknowledgement

Grant support: This work was supported by the Ministry of Science and Technology, Republic of Korea, Grant No. M10414030002-05N1403-00240.

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F-18 FDG-PET as a routine surveillance tool for the detection of recurrent head and neck squamous cell carcinoma

Summary

Introduction

Section snippets

Subjects

Overall accuracy and predictive value

Discussion

Conclusions

Disclosures

Acknowledgement

Oral Oncol

Int J Radiat Oncol Biol Phys

PET scanning in head and neck oncology: a review

Head Neck

Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2-18F-fluoro-2-deoxy-d-glucose positron emission tomography

Laryngoscope

Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient

Laryngoscope

Usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with a residual structural abnormality after definitive treatment for squamous cell carcinoma of the head and neck

Head Neck

Clinical usefulness of 18F-FDG PET in nasopharyngeal carcinoma patients with questionable MRI findings for recurrence

J Nucl Med

Diagnostic and prognostic value of [18F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma

J Clin Oncol

Evaluation of treatment response to radiotherapy in head and neck cancer with fluorine-18 fluorodeoxyglucose

J Nucl Med

Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2-¹⁸F-fluoro-2-deoxy-d-glucose positron emission tomography

Clinical usefulness of ¹⁸F-FDG PET in nasopharyngeal carcinoma patients with questionable MRI findings for recurrence

Diagnostic and prognostic value of [¹⁸F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma