Objective: Because of the high risk of secondary primary malignancies in addition to possible distant metastases, whole-body evaluation is critically important in patients with head and neck cancer. We evaluated the clinical usefulness of whole-body (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) before initial treatment.
Study design: We performed whole-body FDG PET in 26 patients with head and neck cancer (squamous cell carcinoma, n = 20; salivary gland carcinoma, n = 6) before initial treatment. FDG images were prospectively evaluated, and further imaging studies were performed if required. Final diagnosis for the presence or absence of distant lesions was made by analysis of the pathologic findings of surgical specimens or by analysis of the clinical follow-up data for more than 1 year.
Results: PET images showed FDG avid lesions distant from the head and neck area in 3 of 26 patients (11.5%). Two patients were confirmed to have secondary primary cancer (one with colon cancer in the early stage and another with small lung metastasis from postoperative colon cancer). They were diagnosed and treated properly both for the head and neck cancer and the secondary primary cancer. One patient was confirmed to have large lung metastasis from head and neck cancer, and appropriate treatment was selected.
Conclusions: Whole-body FDG PET has a clinical impact on the management of patients with head and neck cancer by detecting secondary primary malignancies as well as distant metastases.