Cost‐effectiveness of positron emission tomography‐CT in the evaluation of cancer of unknown primary of the head and neck

Smith, Kristine A.; Dort, Joseph C.; Hall, Stephen F.; Rudmik, Luke

doi:10.1002/hed.23830

Cited by 12 publications

(10 citation statements)

References 37 publications

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“…15 Furthermore, this treatment approach has been demonstrated to be cost-effective, particularly for N1 and N2 disease. 16 Overall, PET-CT has a sensitivity of 43%-88%, specificity of 33%-88%, and a detection rate of 15%-50% in the management of CUP (Table 4). [17][18][19][20][21][22] A recent systematic review of 7 studies (246 patients) demonstrates an overall sensitivity of 44% and specificity of 97%.…”

Section: Type and Timing Of Imagingmentioning

confidence: 99%

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AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site

2017

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This article reviews the clinical practice guidelines for head and neck oncology focusing on the management of head and neck cancers of unknown primary (CUP). The primary purpose of this series is to raise awareness of the current guidelines in head and neck oncology by reviewing the recommendations and the evidence supporting such recommendations, particularly those published by the National Comprehensive Cancer Network (NCCN). We review the importance of a thorough history and physical examination, the impact of the American Joint Committee on Cancer (AJCC) eighth edition changes and the importance of immunohistochemistry, the timing and type of imaging, the role of panendoscopy and tonsillectomy (palatine and lingual), and the role of surgery, radiation, and chemotherapy in the primary management of these tumors.

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Section: Type and Timing Of Imagingmentioning

confidence: 99%

“…Last, a Canadian prospective clinical trial demonstrated that patients with cervical metastases from CUP benefited from PET‐CT before endoscopy and biopsy with higher detection rates secondary to more directed biopsies . Furthermore, this treatment approach has been demonstrated to be cost‐effective, particularly for N1 and N2 disease …”

Section: Introductionmentioning

confidence: 99%

AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site

2017

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“…In this context, the advent of FDG-PET-CT has resulted in detection rates of up to 40% of occult primaries not amenable to conventional diagnostic imaging and also helps to further clarify the extent of the disease [10,11]. In this regard, FDG-PET-CT has been demonstrated as a cost-effective measure in patients with N1 and N2 status [12].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

Radiotherapeutic management of cervical lymph node metastases from an unknown primary site – experiences from a large cohort treated with modern radiation techniques

et al. 2020

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Purpose: To analyze management and outcomes following (chemo)radiation therapy in patients with cervical lymph node metastases from an unknown primary site (CCUP) in a large single-center cohort.Methods: Between 2008 and 2019, 58 patients with CCUP were treated with (chemo)radiation therapy at the University of Freiburg Medical Center and were included in this analysis. Overall survival (OS), locoregional progression-free survival (PFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The use of diagnostic procedures and their impact on oncological outcomes was analyzed by Cox regression, and treatment-related toxicities were quantified.Results: Median follow-up was 29.9 months (range 4.6-121.9). Twenty-one patients (36.2%) received definitive RT, 35 (60.3%) underwent adjuvant RT, and 2 (3.4%) were treated for oligometastatic disease. Concurrent chemotherapy was prescribed in 40 patients (69.0%). 89.6% of patients completed the prescribed RT, and 65.0% completed the prescribed simultaneous chemotherapy. Locoregional recurrence was observed in 7 patients (12.1%) and distant metastases in 13 cases (22.4%). OS was 81,1, 64.9% and 56,6% after 1, 3 and 5 years, respectively. Univariate analysis of age, gender, extracapsular spread, tumor grading, neck dissection, diagnostic utilization of 18 Ffluorodeoxyglucose positron-emission tomography and concomitant chemotherapy showed no effect on OS (p > 0.05 for all), while smoking was significantly associated with decreased survival (p < 0.05). There was a trend towards impaired OS for patients with advanced nodal status (pN3) (p = 0.07). Three patients (5.2%) experienced grade 3 radiation dermatitis, and 12 (22.4%) developed grade 3 and 1 (1.7%) grade 4 mucositis.(Continued on next page)

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“…In the setting of node-positive HNSCC with unknown primary site prospective analysis suggests FDG PET-CT detects the primary site in approximately 30% of cases where CT and/or MRI is negative or inconclusive 66 . As the yield of FDG PET-CT is relatively low a streamlined approach for optimal utility is advocated with cross-sectional imaging review by a subspecialty Head & Neck Radiologist prior to considering FDG PET-CT. A recent study evaluated the cost-effectiveness of FDG PET-CT in the assessment of cancer of unknown primary in the head and neck and found that it was a cost-effective method in patients with nodal disease confined to one side of the neck but the effectiveness was less certain in more extensive nodal disease 67 .…”

Section: Head and Neck Malignancymentioning

confidence: 99%

PET-CT in the UK: current status and future directions

Scarsbrook

Barrington

2016

Clinical Radiology

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Positron emission tomography-computed tomography (PET-CT) has taken the oncological world by storm since being introduced into the clinical domain in the early 21 st century and is firmly established in the management pathway of many different tumour types. Non-oncological applications of PET-CT represent a smaller but steadily growing area of interest. PET-CT continues to be the focus of a large number of research studies and keeping up-to-date with the literature is important but represents a challenge. Consequently guidelines recommending PET-CT usage need to be revised regularly to encompass new developments. The purpose of this article is two-fold: firstly it provides a detailed review of the evidence-base underpinning the major uses of PET-CT in clinical practice which may be of value to a wide-range of individuals including those directly involved with PET-CT and to a much larger group with limited exposure but for whom a précis of the current state-of-play may help inform other radiology and multidisciplinary team (MDT) work; the second purpose is as a companion to revised guidelines on Evidence-Based Indications for PET-CT in the UK (being published concurrently) providing a detailed commentary on new indications with a summary of emerging data supporting these additional clinical uses of the technique.

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Cost‐effectiveness of positron emission tomography‐CT in the evaluation of cancer of unknown primary of the head and neck

Abstract: The use of PET-CT in patients with N1 and N2 CUP is the cost-effective choice. The cost-effectiveness in N3 CUP is questionable and should be used on an individual case basis.

Cited by 12 publications

References 37 publications

AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site

AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site

Radiotherapeutic management of cervical lymph node metastases from an unknown primary site – experiences from a large cohort treated with modern radiation techniques

PET-CT in the UK: current status and future directions

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