Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence

Abstract

BACKGROUND:In head and neck cancer (HNC), 3-month post-treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of posttreatment PET/CT surveillance on outcomes is assessed at 12 and 24 months. METHODS: A 10-year retrospective analysis of HNC patients was carried out with long-term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3-month scans, 175 had 3-and 12-month scans, and 77 had 3-, 12-, and 24-month scans. RESULTS: PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT-detected and clinically detected recurrences, with similar 3-year diseasefree survival (41% vs 46%, P ¼ .91) and 3-year overall survival (60% vs 54%, P ¼ .70) rates. Compared with 3-month PET/CT, 12-month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive. CONCLUSIONS: HNC patients with negative 3-month imaging appear to derive limited benefit from subsequent PET/ CT surveillance. No survival differences were observed between PET/CT-detected and clinically detected recurrences, although larger prospective studies are needed for further investigation.

Early Detection of Recurrent Disease by FDG-PET/CT Leads to Management Changes in Patients With Squamous Cell Cancer of the Head and Neck

“…The results of several prior studies using sequential PET in the follow-up of HNSCC support our findings [6,19,21,22,24]. In a retrospective study of 156 patients treated for HNSCC, the sensitivity and NPV of PET/CT for recurrence were 92.5% and 95%, compared with 55% and 77% for conventional evaluation methods.…”

“…Although there was stage and treatment heterogeneity in the included patient population, heterogeneity was similar to that of other recently published reports [19].…”

“…This study was limited in that the serial PET/CT was at the discretion of the physician and not ordered in a systematic manner, which raises the possibility of a selection bias. A retrospective analysis of 284 patients revealed that 67.5% of the HNSCC relapses were detected by PET/CT in patients with clinically occult disease; of these, 26% were identified at 3 months and 55.5% were identified at 1 year [19]. The design of this study was flawed by sparse imaging frequency [3, 12, 24 months); thus, it is not known whether imaging would detect relapse earlier than clinical symptoms between the imaging time points [19].…”

“…A retrospective analysis of 284 patients revealed that 67.5% of the HNSCC relapses were detected by PET/CT in patients with clinically occult disease; of these, 26% were identified at 3 months and 55.5% were identified at 1 year [19]. The design of this study was flawed by sparse imaging frequency [3, 12, 24 months); thus, it is not known whether imaging would detect relapse earlier than clinical symptoms between the imaging time points [19]. Although it is difficult to prove the actual impact of a diagnostic test on management retrospectively, in our study, the action plan for intervention, essentially curative-intent salvage surgery or chemoradiotherapy, was based on PET findings in 32% of patients and on both PET/CT and simultaneous HRCT in 53% of patients with relapse.…”

Evaluation of spheroid head and neck squamous cell carcinoma cell models in comparison to monolayer cultures

“…Another key problem is recurrence (15), since up to 50% of the patients are confronted with recurrent disease (16). The spheroid cell model may explain tumor biology more precisely and actualize therapy outcomes already in in vitro models.…”