Impact of PET/CT on Staging and Treatment of Advanced Head and Neck Squamous Cell Carcinoma

Jeffery B. Jorgensen, Russell B. Smith, Andrew Coughlin, William C. Spanos, Michele M. Lohr, Steven M. Sperry, Oleg Militsakh, Robert P. Zitsch, Bevan Yueh, Laura M. Dooley, Aru Panwar, Tabitha L.I. Galloway, Nitin A. Pagedar

Research output: Contribution to journalArticle

Abstract

Objective: To understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. Study Design: Prospective blinded study. Setting: Tertiary care cancer center. Subjects and Methods: Informed consent was obtained and data collected from 52 consecutive previously untreated patients with HNSCC and clinical evidence of cervical metastasis. All patients underwent conventional evaluation for HNSCC and whole body PET/CT. Data were evaluated by 5 independent reviewers, who performed TNM staging per the American Joint Committee on Cancer (seventh edition) manual and proposed a treatment plan prior to viewing, and after reviewing, PET/CT. Cases where at least 3 of 5 reviewers agreed were considered significant. Results: There were 0 patients for whom review of the PET/CT altered the T-class assessment (95% CI, 0-6.8), 12 (23.1%) for whom PET/CT altered N classification (95% CI, 12.5-34.5), and 2 (3.8%) for whom PET/CT altered the M classification (95% CI, 0.5-13.2). For 5 patients (9.6%), overall stage was altered per PET/CT review (95% CI, 3.2-21). For 3 patients (5.8%), PET/CT findings prompted reviewers to alter treatment recommendations (95% CI, 1.2-15.9). Conclusion: When added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.

Original languageEnglish (US)
Pages (from-to)261-266
Number of pages6
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume160
Issue number2
DOIs
StatePublished - Feb 1 2019

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Therapeutics
Positron Emission Tomography Computed Tomography
Carcinoma, squamous cell of head and neck
Neoplasm Staging
Informed Consent
Tertiary Care Centers
Neoplasms
Lymph Nodes
Prospective Studies
Neoplasm Metastasis

Keywords

  • PET/CT
  • carcinoma
  • tumor staging

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Impact of PET/CT on Staging and Treatment of Advanced Head and Neck Squamous Cell Carcinoma. / Jorgensen, Jeffery B.; Smith, Russell B.; Coughlin, Andrew; Spanos, William C.; Lohr, Michele M.; Sperry, Steven M.; Militsakh, Oleg; Zitsch, Robert P.; Yueh, Bevan; Dooley, Laura M.; Panwar, Aru; Galloway, Tabitha L.I.; Pagedar, Nitin A.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 160, No. 2, 01.02.2019, p. 261-266.

Research output: Contribution to journalArticle

Jorgensen, JB, Smith, RB, Coughlin, A, Spanos, WC, Lohr, MM, Sperry, SM, Militsakh, O, Zitsch, RP, Yueh, B, Dooley, LM, Panwar, A, Galloway, TLI & Pagedar, NA 2019, 'Impact of PET/CT on Staging and Treatment of Advanced Head and Neck Squamous Cell Carcinoma', Otolaryngology - Head and Neck Surgery (United States), vol. 160, no. 2, pp. 261-266. https://doi.org/10.1177/0194599818794479
Jorgensen, Jeffery B. ; Smith, Russell B. ; Coughlin, Andrew ; Spanos, William C. ; Lohr, Michele M. ; Sperry, Steven M. ; Militsakh, Oleg ; Zitsch, Robert P. ; Yueh, Bevan ; Dooley, Laura M. ; Panwar, Aru ; Galloway, Tabitha L.I. ; Pagedar, Nitin A. / Impact of PET/CT on Staging and Treatment of Advanced Head and Neck Squamous Cell Carcinoma. In: Otolaryngology - Head and Neck Surgery (United States). 2019 ; Vol. 160, No. 2. pp. 261-266.
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abstract = "Objective: To understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. Study Design: Prospective blinded study. Setting: Tertiary care cancer center. Subjects and Methods: Informed consent was obtained and data collected from 52 consecutive previously untreated patients with HNSCC and clinical evidence of cervical metastasis. All patients underwent conventional evaluation for HNSCC and whole body PET/CT. Data were evaluated by 5 independent reviewers, who performed TNM staging per the American Joint Committee on Cancer (seventh edition) manual and proposed a treatment plan prior to viewing, and after reviewing, PET/CT. Cases where at least 3 of 5 reviewers agreed were considered significant. Results: There were 0 patients for whom review of the PET/CT altered the T-class assessment (95{\%} CI, 0-6.8), 12 (23.1{\%}) for whom PET/CT altered N classification (95{\%} CI, 12.5-34.5), and 2 (3.8{\%}) for whom PET/CT altered the M classification (95{\%} CI, 0.5-13.2). For 5 patients (9.6{\%}), overall stage was altered per PET/CT review (95{\%} CI, 3.2-21). For 3 patients (5.8{\%}), PET/CT findings prompted reviewers to alter treatment recommendations (95{\%} CI, 1.2-15.9). Conclusion: When added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.",
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AU - Spanos, William C.

AU - Lohr, Michele M.

AU - Sperry, Steven M.

AU - Militsakh, Oleg

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AU - Yueh, Bevan

AU - Dooley, Laura M.

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AU - Galloway, Tabitha L.I.

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N2 - Objective: To understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. Study Design: Prospective blinded study. Setting: Tertiary care cancer center. Subjects and Methods: Informed consent was obtained and data collected from 52 consecutive previously untreated patients with HNSCC and clinical evidence of cervical metastasis. All patients underwent conventional evaluation for HNSCC and whole body PET/CT. Data were evaluated by 5 independent reviewers, who performed TNM staging per the American Joint Committee on Cancer (seventh edition) manual and proposed a treatment plan prior to viewing, and after reviewing, PET/CT. Cases where at least 3 of 5 reviewers agreed were considered significant. Results: There were 0 patients for whom review of the PET/CT altered the T-class assessment (95% CI, 0-6.8), 12 (23.1%) for whom PET/CT altered N classification (95% CI, 12.5-34.5), and 2 (3.8%) for whom PET/CT altered the M classification (95% CI, 0.5-13.2). For 5 patients (9.6%), overall stage was altered per PET/CT review (95% CI, 3.2-21). For 3 patients (5.8%), PET/CT findings prompted reviewers to alter treatment recommendations (95% CI, 1.2-15.9). Conclusion: When added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.

AB - Objective: To understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. Study Design: Prospective blinded study. Setting: Tertiary care cancer center. Subjects and Methods: Informed consent was obtained and data collected from 52 consecutive previously untreated patients with HNSCC and clinical evidence of cervical metastasis. All patients underwent conventional evaluation for HNSCC and whole body PET/CT. Data were evaluated by 5 independent reviewers, who performed TNM staging per the American Joint Committee on Cancer (seventh edition) manual and proposed a treatment plan prior to viewing, and after reviewing, PET/CT. Cases where at least 3 of 5 reviewers agreed were considered significant. Results: There were 0 patients for whom review of the PET/CT altered the T-class assessment (95% CI, 0-6.8), 12 (23.1%) for whom PET/CT altered N classification (95% CI, 12.5-34.5), and 2 (3.8%) for whom PET/CT altered the M classification (95% CI, 0.5-13.2). For 5 patients (9.6%), overall stage was altered per PET/CT review (95% CI, 3.2-21). For 3 patients (5.8%), PET/CT findings prompted reviewers to alter treatment recommendations (95% CI, 1.2-15.9). Conclusion: When added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.

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