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Positron Emission Tomography in the Early Follow-up of Advanced Head and Neck Cancer
Gerhard W. Goerres, MD;
Daniel T. Schmid, MD;
Florian Bandhauer, MD;
Pia U. Huguenin, MD;
Gustav K. von Schulthess, MD, PhD;
Stephan Schmid, MD;
Sandro J. Stoeckli, MD
Arch Otolaryngol Head Neck Surg. 2004;130:105-109.
Objective To assess the clinical effect of an early follow-up positron emission tomography (PET) examination at the time of the first routine clinical control in patients with advanced-stage head and neck squamous cell carcinoma (HNSCC).
Design Prospective, nonrandomized, case-control study.
Setting Single referral center.
Patients and Intervention A total of 26 patients (mean age, 56 years) with histologically confirmed stage III-IV HNSCC underwent PET before and approximately 6 weeks after the end of a combined treatment with radiation and chemotherapy with curative intent. The PET findings were confirmed by histologic analysis and a 6-month clinical follow-up.
Main Outcome Measures The presence of distant metastases, secondary synchronous cancers, and residuallocoregional tissue was confirmed, and the effect on further clinical management was assessed.
Results Using PET, we correctly identified residual tumor tissue, distant metastases, or a second primary tumor in 10 patients, 5 of whom had no clinical evidence of such findings. Results were true negative in 14 cases; false positive in 1; and false negative in 1. Sensitivity and specificity for follow-up PET scans were 90.9% and 93.3%, respectively. All patients with positive findings were evaluated for further treatment such as salvage surgery.
Conclusions Whole-body PET scanning approximately 6 weeks after completion of a combined treatment regimen with radiation and chemotherapy can reliably identify locoregional residual cancer and distant metastases or secondary tumors in patients with advanced-stage HNSCC and has a direct influence on management decisions.
From the Division of Nuclear Medicine (Drs Goerres, D. Schmid, and von Schulthess) and the Departments of Otorhinolaryngology–Head and Neck Surgery (Drs Bandhauer, S. Schmid, and Stoeckli), and Radiation Oncology (Dr Huguenin), University Hospital Zurich, Zurich, Switzerland. The authors have no relevant financial interest in this article.
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