Prognostic value of post-treatment (18)F-FDG PET/CT for advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy.

OBJECTIVE: To clarify the prognostic value of post-treatment (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with advanced head and neck squamous cell carcinoma (HNSCC) after combined intra-arterial chemotherapy and radiotherapy (IACR). METHODS: Thirty-six patients with HNSCC who underwent IACR were recruited. The period from the end of IACR to the last post-treatment (18)F-FDG PET/CT examination was 8-12 weeks. Both patient-based and lesion-based analyses were used to evaluate the PET/CT images. For lesion-based analysis, 36 regions (12 lesions of recurrences and 24 scars at primary sites) were selected. The Kaplan-Meier method was used to assess the overall survival (OS) stratified by (18)F-FDG uptake or visual interpretation results. RESULTS: Twelve patients with recurrence were identified by six months after IACR. The sensitivity and specificity in the patient-based analysis were 67% (8/12) and 88% (21/24), respectively. The mean OS was estimated to be 12.1 months (95% CI, 6.3-18.0 months) for the higher maximum standardized uptake value (SUVmax) group (n=7) and 44.6 months (95% CI, 39.9-49.3 months) for the lower SUVmax group (n=29). OS in the higher SUVmax group (cut-off point, 6.1) or positive visual interpretation group was significantly shorter than that in the lower SUVmax or negative visual interpretation group (P<0.001 and P<0.05, respectively). CONCLUSIONS: The SUVmax and visual interpretation of HNSCC on post-IACR (18)F-FDG PET/CT can provide prognostic survival estimates.

Comparison of 18F-FDG and 11C-choline PET/CT for detecting recurrences in patients with nonsquamous cell head and neck malignancies.

OBJECTIVE: The aim of this retrospective study was to evaluate the usefulness of F-fluorodeoxyglucose (FDG) and C-choline positron emission tomography (PET)/computed tomography (CT) for detecting recurrences of nonsquamous cell head and neck malignancies after chemotherapy and radiotherapy. METHOD: Fourteen patients (10 men and four women; mean age: 53.7 ± 14.5 years) with advanced nonsquamous cell head and neck malignancies other than squamous cell carcinoma were recruited. F-FDG and C-choline PET/CT examinations were performed in all the patients after chemotherapy and radiotherapy. The PET/CT images were evaluated using a visual analysis and a region-based analysis. After the posttreatment PET/CT examination, all the patients underwent further surveillance using the conventional imaging methods. RESULTS: Recurrences were eventually confirmed in eight patients after the posttreatment PET/CT examination. The region-based analysis showed that the maximum standardized uptake values for F-FDG and C-choline were strongly correlated with each other (R=0.84). The C-choline PET/CT clearly detected the lesions in two patients, one with severe diabetes mellitus and one with a brain lesion. CONCLUSION: The abilities of F-FDG and C-choline PET/CT to detect lesions were almost the same in this study. In addition, choline has a superior potential for imaging skull base and intracranial lesions because the normal brain is not choline avid.

18F-FDG versus 11C-choline PET/CT for the imaging of advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy: the time period during which PET/CT can reliably detect non-recurrence.

PURPOSE: The purpose of this prospective study was to evaluate the usefulness of (18)F-fluorodeoxyglucose (FDG) and (11)C-choline positron emission tomography (PET)/computed tomography (CT) for detecting recurrences of advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy. Additionally, we surveyed the time period during which an effective negative predictive value could be maintained after the first follow-up PET/CT examination and estimated the optimal timing of a second PET/CT examination for detecting late recurrences. METHODS: Fifty-three subjects (36 men and 17 women; mean age: 59.4 +/- 11.5 years) with advanced head and neck squamous cell carcinoma were recruited. Post-treatment (18)F-FDG PET/CT and (11)C-choline examinations were performed in all patients between 8 and 12 weeks after combined intra-arterial chemotherapy and radiotherapy. The PET/CT images were evaluated using a patient-based analysis and a lesion-based analysis. All of the patients were prospectively followed for at least 9 months after the post-treatment PET/CT examination, with surveillance using conventional images (including CT and/or MRI) and a physical examination performed every 3 months. RESULTS: Recurrences, as determined using the patient-based analysis, were eventually confirmed in 18, 6 and 5 patients at 3, 4-6 and 7-9 months after the post-treatment PET/CT examination, respectively. The sensitivity and specificity of the 18F-FDG PET/CT and the 11C-choline PET/CT examinations to predict recurrence within 3 months were higher (FDG: 89 and 91%; choline: 83 and 80%, respectively) than for recurrence detection 6 months (FDG: 67 and 90%; choline: 62 and 76%, respectively) and 9 months later (FDG: 59 and 92%; choline: 55 and 75%, respectively). The lesion-based analysis showed that the maximum standardized uptake value of (18)F-FDG and (11)C-choline in the recurrent lesions were correlated with each other, compared with their relation in scar tissues (R (2) = 0.492 and 0.197, respectively). CONCLUSION: (11)C-choline was not superior to (18)F-FDG for the detection of recurrent head and neck cancer. Both modalities had difficulty identifying recurrences at 4-9 months after the post-treatment PET/CT examination. In patients with advanced head and neck cancer who have received combined therapy, a second post-treatment PET/CT examination to check for late recurrences should be performed within 4-6 months after the first post-treatment PET/CT examination.

Management of the patients with hypopharyngeal cancer: eight-year experience of Miyagi Cancer Center in Japan.

The aim of this study is to evaluate the results of treatment for hypopharyngeal cancer and indicate the future prospect of the treatment. Seventy-four patients with squamous cell carcinoma of the hypopharynx admitted to Miyagi Cancer Center from 1993 through 2000 are reviewed. Sixty-four patients received radical treatment, and 10 patients received palliative treatment or no treatment. The cancer was advanced (stages III and IV) in 82% of all the patients. The overall 5-year survival rate of all the patients was 38%. The overall 5-year survival rate of 64 patients received radical treatment was 43%. The ten patients who received palliative treatment or no treatment died of cancer within 16 months. Fifty-two out of the 74 patients underwent neck dissection for the neck lymph node involvement; forty of the 52 patients underwent ipsilateral neck dissection and 12 underwent bilateral neck dissection. Four out of the 40 patients, who underwent ipsilateral neck dissection alone, developed late contralateral regional recurrence but were successfully treated by contralateral neck dissection at the time of recurrence. Twenty-three out of 74 patients had multiple primary cancers synchronously or metachronously (31%). Cause of the death of six patients out of 74 patients was confirmed to be primary cancers other than hypopharyngeal cancer, as judged by physicians in other department or other hospitals. Most of the patients died due to distant metastasis from hypopharyngeal cancer or other primary cancers. We therefore conclude that contralateral elective neck dissection which is frequently chosen for the treatment of hypopharyngeal cancer surgery is unnecessary. Even if locoregional control is accomplished, distant metastasis or multiple primary cancers emerge and make prognosis poor. To improve the prognosis, we should develop some strategy against hypopharyngeal cancer for each patient. New strategies including chemoprevention and surgery against distant metasistasis are necessary.

FDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT.

In advanced head and neck cancer, an organ-sparing approach comprising radiation therapy combined with intra-arterial chemotherapy has become an important technique. However, the high incidence of residual masses after therapy remains a problem. In this study, we prospectively evaluated the use of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) delayed imaging for the detection of recurrence of head and neck cancer after radio-chemotherapy, and compared the FDG-PET results with those of magnetic resonance imaging (MRI) or computed tomography (CT). Forty-three lesions from 36 patients with head and neck cancer suspected to represent recurrence after radio-chemotherapy (median interval from therapy, 4 months) were studied. PET was performed at 2 h after FDG injection, and evaluated. The results were compared to those of contrast studies with MRI or CT performed within 2 weeks of the PET study, and to histological diagnosis (in all patients suspected of having recurrence) or clinical diagnosis. The lesion-based sensitivity (visual interpretation) and negative predictive value of FDG-PET (88% and 91%, respectively) were higher than those of MRI/CT (75% and 67% respectively). The specificity, accuracy and positive predictive value of FDG-PET (78%, 81% and 70%, respectively) were significantly ( P<0.05) higher than those of MRI/CT (30%, 47% and 39% respectively). Three of six patients with false positive findings had post-therapy inflammation. Receiver operating characteristic (ROC) analysis showed that retrospective evaluation with the standardised uptake ratio yielded the best results (sensitivity 87.5%, specificity 81.5%), followed by visual interpretation and then the tumour/neck muscle ratio. An FDG-PET delayed imaging protocol yielded significantly better results for the detection of recurrence of head and neck cancer after radio-chemotherapy than MRI/CT. Because of the high negative predictive value of FDG-PET (91.3%), if PET is negative, further invasive procedures may be unnecessary.