Faculty Collaboration Database

Comparison of physical examination and fluorodeoxyglucose positron emission tomography/computed tomography 4-6 months after radiotherapy to assess residual head-and-neck cancer. Int J Radiat Oncol Biol Phys 2011 Dec 01;81(5):e825-32

Date

02/09/2011

Pubmed ID

21300450

DOI

10.1016/j.ijrobp.2010.11.072

Scopus ID

2-s2.0-81855184909 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

PURPOSE: To retrospectively compare fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and physical examination 4-6 months after radiotherapy for assessing residual head-and-neck cancer (HNC).

METHODS AND MATERIALS: From July 2002 through March 2006, 52 HNC patients underwent definitive radiotherapy or chemoradiotherapy. Categoric assessments of residual tumor by PET/CT and physical examination 4-6 months after therapy were correlated and compared with clinical outcomes. Pretreatment data, including tumor stage and primary site standardized uptake value, were also gathered retrospectively and correlated with clinical outcomes. Median follow-up time was 58 months.

RESULTS: Twenty-one patients had either locoregionally "positive" (17 of 21) or "equivocal" (4 of 21) PET/CT scans, whereas 31 patients had locoregionally negative scans. Four patients failed treatment and had biopsy-confirmed residual or recurrent local disease. All patients, including patients with locally suspicious scans or examinations who refused biopsies, were followed clinically for a minimum of 29 months after therapy, with no other cases of treatment failure detected during this time. No patient had residual nodal disease after therapy. Sensitivities of PET/CT vs. physical examination for early detection of treatment failure were 100% vs. 50%, whereas the specificities of the two modalities were 64.6% vs. 89.6%, respectively. Higher initial T stage and American Joint Commission on Cancer stage correlated with increased incidence of positive/equivocal PET/CT results and treatment failure. Maximal standardized uptake value was not predictive of any clinical outcome.

CONCLUSIONS: A negative result on PET/CT obtained 4-6 months after radiotherapy is highly sensitive and correlates with successful locoregional control. Patients with negative scans may reasonably be spared invasive diagnostic procedures, such as biopsy and neck dissection, unless recurrent disease is suspected on clinical grounds. Close follow-up is prudent for HNC patients with abnormal findings on posttherapy PET/CT scan.

Author List

Zundel MT, Michel MA, Schultz CJ, Maheshwari M, Wong SJ, Campbell BH, Massey BL, Blumin J, Wilson JF, Wang D

Authors

Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
Bruce H. Campbell MD Emeritus Professor in the Otolaryngology department at Medical College of Wisconsin
Mohit Maheshwari MD Professor in the Radiology department at Medical College of Wisconsin
Becky Massey MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Michelle A. Michel MD Adjunct Professor in the Radiology department at Medical College of Wisconsin
Christopher J. Schultz MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin
J Frank Wilson MD Professor Emeritus in the Radiation Oncology department at Medical College of Wisconsin
Stuart J. Wong MD Center Director, Professor in the Medicine department at Medical College of Wisconsin
Michael Tracy Zundel MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Chemoradiotherapy
Female
Fluorodeoxyglucose F18
Follow-Up Studies
Head and Neck Neoplasms
Humans
Male
Middle Aged
Multimodal Imaging
Neoplasm, Residual
Physical Examination
Positron-Emission Tomography
Radiopharmaceuticals
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
Treatment Failure
Young Adult