Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography After Concurrent Chemoradiotherapy in Locally Advanced Head-and-Neck Squamous Cell Cancer: The ECLYPS Study

Abstract

Purpose To assess the standardized implementation and reporting of surveillance [F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan of the neck in locoregionally advanced head-and-neck squamous cell carcinoma (LAHNSCC) after concurrent chemoradiotherapy (CCRT). Patients and Methods We performed a prospective multicenter study of FDG-PET/CT scanning 12 weeks after CCRT in newly diagnosed patients with LAHNSCC (stage IVa/b) that used standardized reconstruction and Hopkins reporting criteria. The reference standard was histology or > 12 months of clinical follow-up. The primary outcome measure was the negative predictive value (NPV) of FDG-PET/CT scans and other supporting diagnostic test characteristics, including time dependency with increasing follow-up time. Results Of 152 patients, 125 had adequate primary tumor control after CCRT and entered follow-up (median, 20.4 months). Twenty-three (18.4%) had residual neck disease. Overall, NPV was 92.1% (95% CI, 86.9% to 95.3%; null hypothesis: NPV = 85%; P = .012) with sensitivity of 65.2% (95% CI, 44.9% to 81.2%), specificity of 91.2% (95% CI, 84.1% to 95.3%), positive predictive value of 62.5% (95% CI, 45.5% to 76.9%), and accuracy of 86.4% (95% CI, 79.3% to 91.3%). Sensitivity was time dependent and high for residual disease manifesting up to 9 months after imaging but lower (59.7%) for disease detected up to 12 months after imaging. Standardized reporting criteria reduced the number of equivocal reports (95% CI for the difference, 2.6% to 15.0%; P = .003). Test characteristics were not improved with the addition of lymph node CT morphology criteria. Conclusion FDG-PET/CT surveillance using Hopkins criteria 12 weeks after CCRT is reliable in LAHNSCC except for late manifesting residual disease, which may require an additional surveillance scan at 1 year after CCRT to be detected.

Hopkins criteria for residual disease assessment after definitive radiotherapy in nasopharyngeal carcinoma

“…The Hopkins 5‐point scale criteria, using IJV and liver as reference sites, have shown exceptional inter‐reader agreement in response assessment in HNSCC. The sensitivity, specificity, NPV, PPV, and accuracy of Hopkins criteria was 65%‐68%, 87%‐92%, 91%‐96%, 33%‐71%, and 85%‐87%, respectively . Our study echoes the findings in HSNCC.…”

What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis

“…In terms of study design, most included studies (21/25, 84%) were retrospective. Two papers were initially retrieved in abstract form [ 33 , 41 ] and updated as soon as the full versions became available [ 34 , 42 ]. One study [ 29 ] had limited data on the disease and treatment characteristics collected in most patients, but provided adequate information on FDG PET variables and outcomes.…”

“…As a single variable, MTV and SUV max were the main metabolic parameters addressed in nine and seven studies, respectively. A qualitative analysis was used in three studies [ 29 , 31 , 42 ]. Zschaeck et al [ 44 ] determined SUV mean in irradiated normal mucosa tissue to explore the impact of off-target hypermetabolism and its change over time.…”

Head and neck tumors angiogenesis imaging with 68Ga-NODAGA-RGD in comparison to 18F-FDG PET/CT: A pilot study.

“…It shows that: (1) every primary HNSCC tumour and lymph nodes were visually detectable with both tracers, but with different uptake patterns; (2) 68 Ga-NODAGA-RGD uptake was heterogeneous with a low target-to-background ratio while 18 F-FDG uptake is mostly homogeneous with higher target-to-background ratio; and (3) 68 Ga-NODAGA-RGD uptake was not related to tumor grade, p16 or HPV status. 18 F-FDG PET-CT has a high clinical value in the initial workup and follow-up of patients with HNSCC tumors [4][5][6][7]. It however only allows evaluation of tumor cells metabolism but not neoangiogenesis.…”