Results of a prospective study of positron emission tomography–directed management of residual nodal abnormalities in node‐positive head and neck cancer after definitive radiotherapy with or without systemic therapy

Abstract

PET-directed management of the neck after definitive RT in node-positive HNSCC appropriately spares neck dissections in patients with PET-negative residual CT nodal abnormalities.

Assessment of outcomes with delayed18F-FDG PET-CT response assessment in head and neck squamous cell carcinoma

“…A major difference in our series is that response assessment was performed at a median of 17.4 weeks post treatment, which is considerably later than in most published reports. 10,[13][14][15] To the best of our knowledge, only one other group has reported the use of a "delayed" response assessment PET-CT at 4-6 months post treatment in a series of 52 patients; 19 in this study, the NPV of PET-CT for both the primary and nodal disease was 100%. These data raise the possibility that increasing the interval from completion of treatment maximizes the NPV of PET-CT, increasing confidence in avoiding surgical intervention.…”

“…These test characteristics are particularly important with regard to lymph node response and the ongoing debate regarding the role of a "planned" neck dissection; a high NPV for persistent neck disease would provide a justification to omit neck dissection, whereas the PPV would determine how useful PET-CT is in correctly selecting patients who do require neck dissection. Reported PPVs and NPVs have varied across studies 10,[12][13][14][15] and are likely to be affected by multiple factors, including patients, cancer and treatment characteristics, method of interpretation and timing of post-treatment imaging.…”

Using FDG-PET to Measure Early Treatment Response in Head and Neck Squamous Cell Carcinoma: Quantifying Intrinsic Variability in Order to Understand Treatment-Induced Change

“…2,3 Another area of active investigation is the use of PET to monitor therapy response during treatment. PET performed early in treatment (intratreatment PET) could detect favorable or unfavorable metabolic changes before anatomic changes are evident and could help determine whether a particular therapeutic strategy should be maintained or changed.…”

Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma

“…The PPVs ranged from 43 to 63% when equivocal PET findings were classified as positive PET findings and from 71.1 to 77.8% when equivocal PET findings were classified as negative PET findings. [29][30][31][32] Considering previously reported results, the PPVs might be increased if we excluded equivocal PET findings from the definition of positive PET criteria, but the PPVs in that studies seemed also to be suboptimal to determine the necessity of salvage treatment. Further studies appear to be needed to evaluate the appropriate interpretation and management of equivocal PET findings.…”