Positron emission tomography–computed tomography surveillance for the node‐positive neck after chemoradiotherapy

Rabalais, Amy G.; Walvekar, Rohan R.; Nuss, Daniel W.; McWhorter, Andrew J.; Wood, Charles; Fields, Robert S.; Mercante, Donald E.; Pou, Anna M.

doi:10.1002/lary.20201

Cited by 38 publications

(19 citation statements)

References 17 publications

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“…Similar data (Table 2) has been published by using PET-CT for excluding residual locoregional disease after definitive chemoradiotherapy for HNSCC [40–45]. Ong et al showed that the sensitivity and specificity are higher if the PET-CT study is performed after 12 weeks or more from the end of chemoradiotherapy.…”

Section: Pet For Neck Evaluation After Definitive Chemoradiotherapy Fsupporting

confidence: 77%

Positron Emission Tomography for Neck Evaluation Following Definitive Treatment with Chemoradiotherapy for Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

Bar‐Ad¹,

Mishra²,

Ohri³

et al. 2012

RRCT

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Objectives The objective of the current review was to assess published data on the role of Positron Emission Tomography (PET) for evaluation of nodal residual disease after definitive chemoradiotherapy for head and neck squamous cell carcinoma (HNSCC). Methods Studies were identified by searching PubMed electronic databases. Only studies using a post-chemoradiotherapy PET for nodal residual disease evaluation were included in the present review. Both prospective and retrospective studies were included. Information regarding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET for detecting nodal residual disease after definitive chemoradiotherapy for HNSCC was extracted and analyzed. Results Twenty published studies were included in the present review. Existing data suggest that a negative post-chemoradiotherapy PET scan is associated with a negative predictive value up to 100%. The sensitivity of PET in detecting nodal residual disease is greater for scans performed ≥ 10 weeks after definitive treatment with chemoradiotherapy for HNSCC. Conclusions Further studies are needed to quantify the reliability of PET in detecting nodal residual disease after chemoradiotherapy for locoregionally advanced HNSCC. The optimal timing of PET imaging after chemoradiotherapy remains to be defined.

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Section: Pet For Neck Evaluation After Definitive Chemoradiotherapy Fsupporting

confidence: 77%

Positron Emission Tomography for Neck Evaluation Following Definitive Treatment with Chemoradiotherapy for Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

Bar‐Ad¹,

Mishra²,

Ohri³

et al. 2012

RRCT

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“…PET-CT scans were obtained in standard protocol as previously described in a prior study from our institution [14]. …”

Section: Methodsmentioning

confidence: 99%

PET-CT staging of the neck in cancers of the oropharynx: patterns of regional and retropharyngeal nodal metastasis

et al. 2010

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ObjectiveTo study the retropharyngeal lymph node status (RPLN) by pretreatment PET-CT imaging in patients with squamous cell carcinomas of the oropharynx (OPSCC). Study Design: Retrospective.Methods101 patients with a biopsy proven OPSCC were identified. 53 patients meeting inclusion criteria were further analyzed.ResultsThe frequency of RPLN was 20.8% (11/53). Advanced T stage cancer (OR = 5.6250, 95% CI: 1.06 - 29.80, p = 0.0410) and advanced clinical N stage cancer (i.e. N2+) had higher odds (OR = 3.9773, 95% CI: 0.9628 - 16.4291) of being RPLN positive as compared to N0-1 patients.ConclusionsPre-treatment PET-CT can be used as a staging tool to aid in treatment planning of OPSCC, as rates of RPLN and nodal metastasis are consistent with those reported in the literature. Advanced T and N stage are associated with a greater odds ratio of being RPLN positive by PET-CT imaging.

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“…26 There is a great deal of interest and excitement regarding the use of PET/CT as a modality for observing posttreatment response in the neck, and evidence suggests that PET/CT imaging has a greater than 94% NPV in nodal response. 9,11,27,28 A retrospective review of 65 patients with head and neck SCC by Ong et al 29 found PET/CT with an NPV of 97% in the neck. Chen et al 10 prospectively evaluated a group of 30 patients and found that PET/CT was superior to contrast-enhanced CT alone, with greater accuracy and specificity in assessing regional disease.…”

Section: Commentmentioning

confidence: 99%

“…Recent studies using PET/CT in the evaluation of treatment response in the neck have not routinely used SUV thresholds for deciding clinical response; instead, response was based on other factors such as focal uptake as visually determined with respect to the background activity that corresponded to a structural abnormality. 10-12,28,31 This is in contrast to the evaluation of PET imaging in the clinical staging of head and neck carcinomas, whereby SUV thresholds have been used to evaluate the likelihood of aggressive disease, response to therapy, and patient outcome. 32-34 Herein, we reported using cutoffs of SUV 2 and 2.5 in PET/CT performed on average 90.5 days after completion of treatment to evaluate treatment response in the neck, with a better NPV obtained with a PET/CT SUV threshold of 2.…”

Section: Commentmentioning

confidence: 99%

Retrospective Review of Positron Emission Tomography With Contrast-Enhanced Computed Tomography in the Posttreatment Setting in Human Papillomavirus–Associated Oropharyngeal Carcinoma

Chan¹,

Sanguineti²,

Richmon³

et al. 2012

Arch Otolaryngol Head Neck Surg

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Objective To determine the value of positron emission tomography (PET) with contrast-enhanced computed tomography (CT) in assessing the need for neck dissection by retrospectively reviewing the pathology reports of patients with human papillomavirus (HPV)- associated oropharyngeal squamous cell carcinoma (SCC). Design Retrospective cohort study. Setting Tertiary medical center. Patients Seventy-seven patients with HPV-related SCC. Main Outcome Measures Seventy-seven consecutive patients with a diagnosis of HPV-related SCC who were treated with radiotherapy as the primary treatment between August 2007 and October 2010 were retrospectively evaluated for radiologic and pathologic rate of persistence of nodal metastasis after completion of definitive radiotherapy. Pretreatment and posttreatment imaging included contrast-enhanced CT and PET. Response to treatment was measured on CT, PET at standardized uptake value (SUV) thresholds of 2 and 2.5, and PET/CT by a neuroradiologist in a blinded fashion. Then, the pathology report of the patients who underwent neck dissections was reviewed for nodal status after resection and correlated with the imaging findings. Results Of the 77 patients, 67 met the study criteria, with an average follow-up PET/CT scan at 90.5 days after completion of radiotherapy. Ten patients did not undergo follow-up PET/CT imaging. Twenty patients underwent neck dissections after completion of radiation therapy. Of these 20 patients, 4 had persistent tumor and 16 did not have viable tumor. Using the final pathology report to correlate with imaging responses, CT had a negative predictive value (NPV) of 85.7% (95% CI, 48.7%-97.4%), PET with SUV thresholds of 2 had an NPV of 91.7% (95% CI, 64.6%-98.5%), PET with a cutoff SUV of 2.5 had an NPV of 85.7% (95% CI, 60.1%-96.0%), PET/CT with an SUV of 2 had an NPV of 100% (95% CI, 59.8%-100.0%), and PET/CT with an SUV of 2.5 had an NPV of 85.7% (95% CI, 48.7%-97.4%). The 47 patients who did not undergo neck dissection had a median follow-up of 26 months without an isolated neck failure. Analysis of all 67 patients in the cohort revealed the following values: CT had an NPV of 95.7% (95% CI, 85.8%-98.8%), PET with an SUV of 2 had an NPV of 98.2% (95% CI, 90.4%-99.7%), PET with an SUV of 2.5 had an NPV of 95.0% (95% CI, 86.3%-98.3%), PET/CT with an SUV of 2 had an NPV of 100.0% (95% CI, 92.0%-100.0%), and PET/CT with an SUV of 2.5 had an NPV of 95.7% (95% CI, 85.8%-98.8%). Conclusions Positron emission tomography combined with contrast-enhanced CT has a better NPV than either imaging modality alone in patients with HPV-associated oropharyngeal SCC. Furthermore, PET/CT with an SUV threshold of 2 used in patients with HPV-related SCC offers an imaging modality with a high NPV that may obviate the need for unnecessary neck dissections.

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Positron emission tomography–computed tomography surveillance for the node‐positive neck after chemoradiotherapy

Abstract: Planned neck dissection can be deferred with a negative post-treatment PET-CT. Assuming a complete response at the primary site and a negative PET-CT scan, there may be a role for serial PET-CT surveillance in patients with residual palpable cervical lymphadenopathy. Laryngoscope, 2009.

Cited by 38 publications

References 17 publications

Positron Emission Tomography for Neck Evaluation Following Definitive Treatment with Chemoradiotherapy for Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

Positron Emission Tomography for Neck Evaluation Following Definitive Treatment with Chemoradiotherapy for Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

PET-CT staging of the neck in cancers of the oropharynx: patterns of regional and retropharyngeal nodal metastasis

Retrospective Review of Positron Emission Tomography With Contrast-Enhanced Computed Tomography in the Posttreatment Setting in Human Papillomavirus–Associated Oropharyngeal Carcinoma

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