ABSTRACT
PURPOSE: RECIST have limitations when applied to potentially curable locally advanced squamous cell carcinoma of the head and neck (SCCHN). [¹8F]fluorodeoxyglucose-positron emission tomography (PET) scan may be useful in assessing treatment response and predicting patient outcome. PATIENTS AND METHODS: We studied patients with previously untreated stages III-IVb SCCHN treated with primary concurrent chemoradiotherapy on five prospective clinical trials. Response was assessed by clinical exam, computed tomography (CT), and PET portions of combined PET-CT scan â¼8 weeks after completion of chemoradiotherapy. RESULTS: Fifty-three patients were analyzed. Complete response (CR) was demonstrated in 42 patients (79%) by clinical exam, 15 (28%) by CT, and 27 (51%) by PET. CR as assessed by PET, but not as assessed by clinical exam or CT using RECIST, correlated significantly with progression-free status (PFS) (P < 0.0001). The 2-year PFS for patients with CR and without CR by PET was 93% and 48%, respectively (P = 0.0002). CONCLUSIONS: A negative PET scan on combined PET-CT after chemoradiotherapy is a powerful predictor of outcome in patients receiving curative chemoradiotherapy for SCCHN. PET-CT is indicated for response evaluation in this setting to improve the accuracy of post-treatment assessment by CT.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/therapy , Positron-Emission Tomography , Tomography, X-Ray Computed , Adult , Aged , Carcinoma, Squamous Cell/pathology , Combined Modality Therapy , Female , Fluorodeoxyglucose F18 , Head and Neck Neoplasms/pathology , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Prospective Studies , Radiopharmaceuticals , Radiotherapy Dosage , Survival Rate , Treatment Outcome , Young AdultABSTRACT
An innovative educational program on developmental care of the neonate was successfully implemented within the high-tech environment of a Level III NICU. Devised by a multidisciplinary team, the program provided appropriate levels of education to all personnel--from neonatologists to housekeeping staff--involved on a day-to-day basis with the infants. To assist those wishing to implement a similar program in their institution, details of program development, content, implementation, evaluation, and future goals are discussed.
