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Title: Comparison of Physical Examination and Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 4-6 Months After Radiotherapy to Assess Residual Head-and-Neck Cancer

Abstract

Purpose: To retrospectively compare fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and physical examination 4-6 months after radiotherapy for assessing residual head-and-neck cancer (HNC). Methods and Materials: From July 2002 through March 2006, 52 HNC patients underwent definitive radiotherapy or chemoradiotherapy. Categoric assessments of residual tumor by PET/CT and physical examination 4-6 months after therapy were correlated and compared with clinical outcomes. Pretreatment data, including tumor stage and primary site standardized uptake value, were also gathered retrospectively and correlated with clinical outcomes. Median follow-up time was 58 months. Results: Twenty-one patients had either locoregionally 'positive' (17 of 21) or 'equivocal' (4 of 21) PET/CT scans, whereas 31 patients had locoregionally negative scans. Four patients failed treatment and had biopsy-confirmed residual or recurrent local disease. All patients, including patients with locally suspicious scans or examinations who refused biopsies, were followed clinically for a minimum of 29 months after therapy, with no other cases of treatment failure detected during this time. No patient had residual nodal disease after therapy. Sensitivities of PET/CT vs. physical examination for early detection of treatment failure were 100% vs. 50%, whereas the specificities of the two modalities were 64.6% vs. 89.6%, respectively. Higher initial T stage and Americanmore » Joint Commission on Cancer stage correlated with increased incidence of positive/equivocal PET/CT results and treatment failure. Maximal standardized uptake value was not predictive of any clinical outcome. Conclusions: A negative result on PET/CT obtained 4-6 months after radiotherapy is highly sensitive and correlates with successful locoregional control. Patients with negative scans may reasonably be spared invasive diagnostic procedures, such as biopsy and neck dissection, unless recurrent disease is suspected on clinical grounds. Close follow-up is prudent for HNC patients with abnormal findings on posttherapy PET/CT scan.« less

Authors:
 [1];  [2];  [1];  [2];  [3]; ; ;  [4];  [1];  [1]
  1. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)
  2. Department of Radiology, Medical College of Wisconsin, Milwaukee, WI (United States)
  3. Department of Neoplastic and Related Disorders, Medical College of Wisconsin, Milwaukee, WI (United States)
  4. Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI (United States)
Publication Date:
OSTI Identifier:
22054513
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 81; Journal Issue: 5; Other Information: Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOPSY; CAT SCANNING; COMBINED THERAPY; FAILURES; FLUORODEOXYGLUCOSE; HEAD; NECK; NEOPLASMS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; RADIOTHERAPY; SENSITIVITY; SPECIFICITY

Citation Formats

Zundel, M Tracy, Michel, Michelle A, Schultz, Christopher J, Maheshwari, Mohit, Wong, Stuart J, Campbell, Bruce H, Massey, Becky L, Blumin, Joel, Wilson, J Frank, and Wang, Dian. Comparison of Physical Examination and Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 4-6 Months After Radiotherapy to Assess Residual Head-and-Neck Cancer. United States: N. p., 2011. Web. doi:10.1016/J.IJROBP.2010.11.072.
Zundel, M Tracy, Michel, Michelle A, Schultz, Christopher J, Maheshwari, Mohit, Wong, Stuart J, Campbell, Bruce H, Massey, Becky L, Blumin, Joel, Wilson, J Frank, & Wang, Dian. Comparison of Physical Examination and Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 4-6 Months After Radiotherapy to Assess Residual Head-and-Neck Cancer. United States. https://doi.org/10.1016/J.IJROBP.2010.11.072
Zundel, M Tracy, Michel, Michelle A, Schultz, Christopher J, Maheshwari, Mohit, Wong, Stuart J, Campbell, Bruce H, Massey, Becky L, Blumin, Joel, Wilson, J Frank, and Wang, Dian. 2011. "Comparison of Physical Examination and Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 4-6 Months After Radiotherapy to Assess Residual Head-and-Neck Cancer". United States. https://doi.org/10.1016/J.IJROBP.2010.11.072.
@article{osti_22054513,
title = {Comparison of Physical Examination and Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 4-6 Months After Radiotherapy to Assess Residual Head-and-Neck Cancer},
author = {Zundel, M Tracy and Michel, Michelle A and Schultz, Christopher J and Maheshwari, Mohit and Wong, Stuart J and Campbell, Bruce H and Massey, Becky L and Blumin, Joel and Wilson, J Frank and Wang, Dian},
abstractNote = {Purpose: To retrospectively compare fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and physical examination 4-6 months after radiotherapy for assessing residual head-and-neck cancer (HNC). Methods and Materials: From July 2002 through March 2006, 52 HNC patients underwent definitive radiotherapy or chemoradiotherapy. Categoric assessments of residual tumor by PET/CT and physical examination 4-6 months after therapy were correlated and compared with clinical outcomes. Pretreatment data, including tumor stage and primary site standardized uptake value, were also gathered retrospectively and correlated with clinical outcomes. Median follow-up time was 58 months. Results: Twenty-one patients had either locoregionally 'positive' (17 of 21) or 'equivocal' (4 of 21) PET/CT scans, whereas 31 patients had locoregionally negative scans. Four patients failed treatment and had biopsy-confirmed residual or recurrent local disease. All patients, including patients with locally suspicious scans or examinations who refused biopsies, were followed clinically for a minimum of 29 months after therapy, with no other cases of treatment failure detected during this time. No patient had residual nodal disease after therapy. Sensitivities of PET/CT vs. physical examination for early detection of treatment failure were 100% vs. 50%, whereas the specificities of the two modalities were 64.6% vs. 89.6%, respectively. Higher initial T stage and American Joint Commission on Cancer stage correlated with increased incidence of positive/equivocal PET/CT results and treatment failure. Maximal standardized uptake value was not predictive of any clinical outcome. Conclusions: A negative result on PET/CT obtained 4-6 months after radiotherapy is highly sensitive and correlates with successful locoregional control. Patients with negative scans may reasonably be spared invasive diagnostic procedures, such as biopsy and neck dissection, unless recurrent disease is suspected on clinical grounds. Close follow-up is prudent for HNC patients with abnormal findings on posttherapy PET/CT scan.},
doi = {10.1016/J.IJROBP.2010.11.072},
url = {https://www.osti.gov/biblio/22054513}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 81,
place = {United States},
year = {Thu Dec 01 00:00:00 EST 2011},
month = {Thu Dec 01 00:00:00 EST 2011}
}