Temporal patterns of ¹⁸F‐fluorodeoxyglucose positron emission tomography/computed tomography sinonasal uptake after treatment of sinonasal malignancy

Abstract

Our analysis of PET/CT in patients previously treated for sinonasal malignancy suggests that the posttreatment sinonasal skull base is characterized by a prolonged period of hypermetabolism that endures beyond the period previously described for deep tissue sites of the head and neck. These findings prompt a reevaluation of the previously described 10- to 12-week cutoff point for initial posttreatment PET/CT for head and neck squamous cell carcinoma as applied to sinonasal malignancies.

Utility of first positron emission tomography‐computed tomography scan as a prognostic tool following treatment of sinonasal and skull base malignancies

“…[27][28][29] False results may be due to early postoperative changes, free tissue transfer, or inflammation in the primary site or regional lymph nodes. In a report by Schwartz et al, 25 the period of treatment-induced inflammation persisted for up to twice the duration (>5 months) observed in deep tissue sites of the head and neck; suggesting that sinonasal/skull base lesions respond to oncologic treatment in a manner different from other head and neck subsites. 6 Workman et al 29 concluded that the higher accuracy of FDG-PET/CT in head and neck tumors does not apply to neoplasms in the sinonasal cavity, mostly due to the inflammatory environment that is augmented in the posttreatment sinonasal cavity, which causes nonspecific FDG uptake.…”

“…[4][5][6][7][8][9][10][11] An important advantage of PET/CT is that a whole-body scan allows for the detection of distant metastases and unexpected secondary cancers. [19][20][21][22][23][24][25][26] The purpose of this study was to assess the predictive value of the first posttreatment PET/CT scan with respect to overall survival (OS) in patients with malignancies of the paranasal sinuses and skull base. 12 Although PET/CT is now routinely used for HNSCC pretreatment and posttreatment evaluations, the clinical utility of the first posttreatment PET/CT scan for predicting tumor recurrence and survival of HNSCC had been evaluated in only few publications, and mostly in human papilloma virus-related tumors.…”

“…5,[13][14][15][16][17][18] The diagnostic and prognostic utility of PET/CT is largely undefined in sinonasal and skull base malignancies about which there are only a few studies on relatively small populations. [19][20][21][22][23][24][25][26] The purpose of this study was to assess the predictive value of the first posttreatment PET/CT scan with respect to overall survival (OS) in patients with malignancies of the paranasal sinuses and skull base.…”

What is the appropriate timing for endoscopic and radiographic surveillance following treatment for sinonasal malignancies?

“…They hypothesize that this inflammation persists due to communication of the nose and paranasal sinuses with the external environment, causing subsequent treatment-related disruption of mucociliary clearance. 4 The previously discussed studies highlight several key points. First, most recurrences occur locally within 24 months.…”

“…The authors concluded that post‐treatment inflammation in the sinonasal cavity exists beyond the 12‐week period (commonly cited as the standard in the head and cancer literature), thereby increasing the number of false positives. They hypothesize that this inflammation persists due to communication of the nose and paranasal sinuses with the external environment, causing subsequent treatment‐related disruption of mucociliary clearance …”