The Role of Positron Emission Tomography and Computed Tomography Fusion in the Management of Early-Stage and Advanced-Stage Primary Head and Neck Squamous Cell Carcinoma

Ha, Patrick K.; Hdeib, Alia; Goldenberg, David M.; Jacene, Heather A.; Patel, Pavni; Koch, Wayne M.; Califano, J.; Cummings, Charles W.; Flint, Paul W.; Wahl, Richard L.; Tufano, Ralph P.

doi:10.1001/archotol.132.1.12

Cited by 95 publications

(55 citation statements)

References 19 publications

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“…MR imaging provides superior soft-tissue delineation and better assessment of perineural (Fig 4) and bone marrow extension of the primary tumor. Although PET is highly accurate in the detection of primary tumor, 19,20 the resolution is inferior to CT and MR imaging in depicting the anatomic detail and the extent of the tumor that is essential for surgical planning. PET and PET/CT without contrast do not provide the anatomic detail sufficient for surgical planning purposes.…”

Section: T Stagementioning

confidence: 99%

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Subramaniam

Truong

Peller

et al. 2009

AJNR Am J Neuroradiol

107

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SUMMARY:The hybrid technique of PET/CT has significantly impacted the imaging and management of HNSCC since its introduction in 2001 and has become the technique of choice for imaging of this cancer. Diagnostic FDG-PET/CT is useful for identification of an unknown primary tumor, delineation of extent of primary tumor, detection of regional lymph node involvement even in a normal-sized node, detection of distant metastases and occasional synchronous primary tumor, assessment of therapy response, and long-term surveillance for recurrence and metastases. The role of PET/CT is evolving in radiation therapy planning. Combined diagnostic PET/CT provides the best anatomic and metabolic in vivo information for the comprehensive management of HNSCC.ABBREVIATIONS: CR ϭ complete response; DCT ϭ contrast enhanced diagnostic CT;18 F ϭ fluorine-18; FDG ϭ fluorodeoxyglucose; FDG-PET ϭ fluorodeoxyglucose-positron-emission tomography; FNA ϭ fine-needle aspiration; GTV ϭ gross tumor volume; HNSCC ϭ head and neck squamous cell carcinomas; IMRT ϭ intensity modulated radiation therapy; M ϭ metastasis; N ϭ node; PET ϭ positron-emission tomography; PTV ϭ planning target volume; RD ϭ residual disease; SCC ϭ squamous cell carcinoma; SUV ϭ standard uptake value; SUV max ϭ maximum SUV; T ϭ tumor M ore than 40,000 people are diagnosed with head and neck cancer each year in the United States.1 The overall annual mortality rate for this cancer in the United States is 23%, and the 5-year survival rate is 56%.1-3 More than 80% of early-stage tumors are cured, but nearly one-half of patients have evidence of advanced local disease or lymph node metastases at the time of diagnosis. Surgery and radiation therapy, either alone or in combination with chemotherapy, are used for definitive locoregional treatment of head and neck cancers. For patients with advancedstage and high-risk features, postoperative chemoradiation improves locoregional control and overall survival. 4,5 Cross-sectional imaging with CT and MR imaging is commonly used for tumor staging and may allow detection of subcentimeter lesions. Locoregional lymph node metastases have a major impact on survival. Patients with lymph-node involvement have a worse prognosis (approximately 30%) than patients without lymph node involvement (Ͼ50% 5-year survival). 6,7 PET using the radiotracer 18 F FDG is widely used to evaluate patients with HNSCC. The hybrid technique, PET/CT, provides anatomic and functional information and can be performed as PET and DCT with intravenous contrast-enhancement (PET/ DCT) or PET and noncontrast CT (PET/CT) for attenuation correction and anatomic localization. PET/CT is useful for identification of an unknown primary tumor, delineation of the extent of regional lymph node involvement, detection of distant metastases and occasional synchronous primary tumor, radiation-therapy planning, assessing therapy response, and long-term surveillance for recurrence and metastases.PET/CT Protocols PET/CT imaging was developed to improve PET imaging by expediting attenuation c...

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Section: T Stagementioning

confidence: 99%

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Subramaniam

Truong

Peller

et al. 2009

AJNR Am J Neuroradiol

107

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“…Similar studies have shown that PET/CT significantly alters TNM scores in patients with HNSCC by identifying nodal disease not apparent by CT, MRI, clinical exam, or combination thereof. Koshy and colleagues [20] found that PET/CT altered the TNM score in 36% of 36 patients compared with CT alone, while Ha and colleagues [21] found that PET/CT altered the TNM score in 31% of 36 patients compared with either CT or MRI. In both of these studies, 7 of the 36 patients (19%) had changes to their N status based on the information garnered from PET/CT but not identified on conventional imaging.…”

Section: N Stagementioning

confidence: 99%

Indications for PET/CT in the Head and Neck

Agarwal

Branstetter

Johnson

2008

Otolaryngologic Clinics of North America

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Head and neck cancer accounts for approximately 3% to 5% of all new cancer diagnoses in the United States with 40,000 new cases diagnosed each year [1]. These figures encompass cancers arising from the lip, oral cavity, nasal cavity, paranasal sinuses, pharynx, and larynx, of which the vast majority (90% to 95%) are squamous cell carcinomas arising from mucosal linings of the upper aerodigestive tract. Other, rare cancers that may involve the head and neck include salivary tumors, thyroid cancers, lymphoma, and melanoma.Early diagnosis and accurate staging are essential for treatment planning and can strongly influence prognosis. Likewise, early identification of tumor recurrence can often be treated with additional surgery or re-irradiation. A combination of history, physical exam, endoscopy, and tissue sampling has historically been the mainstay of diagnosis and staging. The use of crosssectional imaging (CT and MRI) has greatly improved staging and monitoring for disease recurrence. Small metastases and/or early recurrent disease, however, can still be missed [2].Functional imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used to fill these gaps and improve characterization of both primary tumors and metastatic disease. PET has been shown to be effective in the diagnosis of many different types of cancer, including head and neck squamous cell carcinoma (HNSCC) [3]; however, the poor spatial resolution of PET and the lack of anatomic landmarks can make exact localization of disease difficult. In addition, normal

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“…However, the extent of nodal involvement was shown correctly by PET/CT only in nine of them. Two patients did not have the lymphatic nodes removed for histopathology examination [6].…”

Section: Discussionmentioning

confidence: 99%

“…PET offers new diagnostic possibilities as it supplements the morphological imaging with a functional view. Numerous studies have shown that PET is superior to CT in identifying primary lesions and metastases in patients with head-and-neck cancer [5,6]. A hybrid PET-CT can provide additional information by combining PET and CT images and create results with increased geometric accuracy.…”

mentioning

confidence: 99%

PET/CT significance for planning radiotherapy of head and neck cancer

Kolářová¹,

Vaňásek²,

Kandrnal³

et al. 2012

neo

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The combination of positron emission tomography and computed tomography (PET/CT) offers metabolic mapping in addition to anatomic information of the primary lesion, nodal and distant metastases in patients with head and neck tumors, and may be therefore beneficial for radiotherapy planning. The aim of our study was to evaluate benefits of combined PET and CT imaging for staging and target volume delineation in this group of patients.Fifty three patients (40 men and 13 women) with confirmed advanced, inoperable or non-radically operated head and neck cancer were assessed based on the results of PET/CT as well as standard diagnostic examinations. All patients were subsequently treated with intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) of 6 MV X-rays.There was an agreement between the standard examinations results and results of PET/CT in 30 cases. In 23 cases there was disagreement either in tumor size, nodal involvement or presence of distant metastases. Results of the tumor size assessment differed significantly in 5 cases. There was no agreement found in nodal involvement in 10 cases. The cancer confirmed by standard examination was not found by PET/CT in 2 cases; 3 PET/CT positive findings were not confirmed by standard examinations. In 3 patients PET-CT revealed new distant metastatic disease. Based on PET/CT assessment we changed treatment strategy and applied potentially curative dose of radiotherapy to previously undiscovered regions in 9 patients. We decided to change the treatment intent in 3 cases and only palliative treatment was applied. Based on our experience and the literature review, PET/CT may be considerable contribution to the standard diagnostic procedures in approximately one third of cases.

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The Role of Positron Emission Tomography and Computed Tomography Fusion in the Management of Early-Stage and Advanced-Stage Primary Head and Neck Squamous Cell Carcinoma

Cited by 95 publications

References 19 publications

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Indications for PET/CT in the Head and Neck

PET/CT significance for planning radiotherapy of head and neck cancer

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