Role of Positron Emission Tomography in the Treatment of Occult Disease in Head-and-Neck Cancer: A Modeling Approach

Journal Article · Tue Mar 15 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.12.037· OSTI ID:21491646

Smith, Wade P ^[1]; Parvathaneni, Upendra; Laramore, George E ^[2]

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1. Department of Veterans Affairs, Albany, NY (United States)
2. Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA (United States)

Purpose: To determine under what conditions positron emission tomography (PET) imaging will be useful in decisions regarding the use of radiotherapy for the treatment of clinically occult lymph node metastases in head-and-neck cancer. Methods and Materials: A decision model of PET imaging and its downstream effects on radiotherapy outcomes was constructed using an influence diagram. This model included the sensitivity and specificity of PET, as well as the type and stage of the primary tumor. These parameters were varied to determine the optimal strategy for imaging and therapy for different clinical situations. Maximum expected utility was the metric by which different actions were ranked. Results: For primary tumors with a low probability of lymph node metastases, the sensitivity of PET should be maximized, and 50 Gy should be delivered if PET is positive and 0 Gy if negative. As the probability for lymph node metastases increases, PET imaging becomes unnecessary in some situations, and the optimal dose to the lymph nodes increases. The model needed to include the causes of certain health states to predict current clinical practice. Conclusion: The model demonstrated the ability to reproduce expected outcomes for a range of tumors and provided recommendations for different clinical situations. The differences between the optimal policies and current clinical practice are likely due to a disparity between stated clinical decision processes and actual decision making by clinicians.

• OSTI ID: 21491646
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 79, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2009.12.037; PII: S0360-3016(09)03703-1; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
HEAD
LYMPH NODES
METASTASES
NECK
NEOPLASMS
POSITRON COMPUTED TOMOGRAPHY
RADIOTHERAPY
SENSITIVITY
SIMULATION
SPECIFICITY
BODY
COMPUTERIZED TOMOGRAPHY
DIAGNOSTIC TECHNIQUES
DISEASES
EMISSION COMPUTED TOMOGRAPHY
LYMPHATIC SYSTEM
MEDICINE
NUCLEAR MEDICINE
RADIOLOGY
THERAPY
TOMOGRAPHY