The role of post-radiation therapy FDG pet in prediction of necessity for post-radiation therapy neck dissection in locally advanced head-and-neck squamous cell carcinoma

Min Yao, Michael M. Graham, Henry T. Hoffman, Russell B. Smith, Gerry F. Funk, Scott M. Graham, Kenneth J. Dornfeld, Mark Skwarchuk, Yusuf Menda, John M. Buatti

Research output: Contribution to journalArticle

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Abstract

Purpose The role of neck dissection after radiation therapy ([RT] with or without chemotherapy) for regionally advanced head and neck cancer is controversial. As much as 50% of residual lymphadenopathy after radiation has no viable tumor cells present on histopathologic analysis. [18F] fluorodeoxyglucose positron emission tomography (FDG PET) imaging can detect metabolically active cancer. This study examines the ability of post-RT FDG PET imaging to predict the tumor status of residual lymphadenopathy after nonsurgical management of regionally advanced neck disease. Methods and material From February 2000 to October 2002, 41 patients were treated definitively by radiation (with or without chemotherapy) and underwent FDG PET and computed tomography (CT) imaging after treatment to assess response. Patients with negative CT and FDG PET scans were observed and did not undergo neck dissection. Patients with radiographically persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration of the lymph nodes using ultrasound guidance. The results of the FDG PET scans were correlated with the pathologic findings. Results Twelve patients with persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration. Four of the 12 were found to have viable residual tumor in the cervical lymph nodes. The pathology did not correlate with the size of the lymph nodes in the pre-RT or post-RT CT studies. However, the pathology correlated strongly with the post-RT FDG PET studies. All patients with a negative post-RT FDG PET or those with a maximum standardized uptake value (SUVmax) of less than 3.0 in the post-RT FDG PET were found to be free of residual viable tumor. Using an SUVmax of less than 3.0 as the criterion for a negative FDG PET study, the negative predictive value was 100% and the positive predictive value was 80%. Conclusions A negative post-RT FDG PET scan is very predictive of negative pathology in neck dissection or fine-needle aspiration even with large residual lymphadenopathy. Therefore, if the post-RT FDG PET scan is negative, neck dissection might not be required for regional control. A prospective study with longer follow-up and greater patient numbers is needed to determine whether a policy of deferring neck dissection based on a negative FDG PET is supported.

Original languageEnglish (US)
Pages (from-to)1001-1010
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume59
Issue number4
DOIs
StatePublished - Jul 15 2004

Fingerprint

dissection
Neck Dissection
Pets
Positron-Emission Tomography
radiation therapy
Radiotherapy
tomography
cancer
positrons
predictions
Residual Neoplasm
Fine Needle Biopsy
lymphatic system
Lymph Nodes
pathology
tumors
Pathology
needles
Carcinoma, squamous cell of head and neck
Radiation

Keywords

  • FDG PET
  • Head and neck cancer
  • Neck dissection
  • Radiation

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

The role of post-radiation therapy FDG pet in prediction of necessity for post-radiation therapy neck dissection in locally advanced head-and-neck squamous cell carcinoma. / Yao, Min; Graham, Michael M.; Hoffman, Henry T.; Smith, Russell B.; Funk, Gerry F.; Graham, Scott M.; Dornfeld, Kenneth J.; Skwarchuk, Mark; Menda, Yusuf; Buatti, John M.

In: International Journal of Radiation Oncology Biology Physics, Vol. 59, No. 4, 15.07.2004, p. 1001-1010.

Research output: Contribution to journalArticle

Yao, Min ; Graham, Michael M. ; Hoffman, Henry T. ; Smith, Russell B. ; Funk, Gerry F. ; Graham, Scott M. ; Dornfeld, Kenneth J. ; Skwarchuk, Mark ; Menda, Yusuf ; Buatti, John M. / The role of post-radiation therapy FDG pet in prediction of necessity for post-radiation therapy neck dissection in locally advanced head-and-neck squamous cell carcinoma. In: International Journal of Radiation Oncology Biology Physics. 2004 ; Vol. 59, No. 4. pp. 1001-1010.
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abstract = "Purpose The role of neck dissection after radiation therapy ([RT] with or without chemotherapy) for regionally advanced head and neck cancer is controversial. As much as 50{\%} of residual lymphadenopathy after radiation has no viable tumor cells present on histopathologic analysis. [18F] fluorodeoxyglucose positron emission tomography (FDG PET) imaging can detect metabolically active cancer. This study examines the ability of post-RT FDG PET imaging to predict the tumor status of residual lymphadenopathy after nonsurgical management of regionally advanced neck disease. Methods and material From February 2000 to October 2002, 41 patients were treated definitively by radiation (with or without chemotherapy) and underwent FDG PET and computed tomography (CT) imaging after treatment to assess response. Patients with negative CT and FDG PET scans were observed and did not undergo neck dissection. Patients with radiographically persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration of the lymph nodes using ultrasound guidance. The results of the FDG PET scans were correlated with the pathologic findings. Results Twelve patients with persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration. Four of the 12 were found to have viable residual tumor in the cervical lymph nodes. The pathology did not correlate with the size of the lymph nodes in the pre-RT or post-RT CT studies. However, the pathology correlated strongly with the post-RT FDG PET studies. All patients with a negative post-RT FDG PET or those with a maximum standardized uptake value (SUVmax) of less than 3.0 in the post-RT FDG PET were found to be free of residual viable tumor. Using an SUVmax of less than 3.0 as the criterion for a negative FDG PET study, the negative predictive value was 100{\%} and the positive predictive value was 80{\%}. Conclusions A negative post-RT FDG PET scan is very predictive of negative pathology in neck dissection or fine-needle aspiration even with large residual lymphadenopathy. Therefore, if the post-RT FDG PET scan is negative, neck dissection might not be required for regional control. A prospective study with longer follow-up and greater patient numbers is needed to determine whether a policy of deferring neck dissection based on a negative FDG PET is supported.",
keywords = "FDG PET, Head and neck cancer, Neck dissection, Radiation",
author = "Min Yao and Graham, {Michael M.} and Hoffman, {Henry T.} and Smith, {Russell B.} and Funk, {Gerry F.} and Graham, {Scott M.} and Dornfeld, {Kenneth J.} and Mark Skwarchuk and Yusuf Menda and Buatti, {John M.}",
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AU - Graham, Michael M.

AU - Hoffman, Henry T.

AU - Smith, Russell B.

AU - Funk, Gerry F.

AU - Graham, Scott M.

AU - Dornfeld, Kenneth J.

AU - Skwarchuk, Mark

AU - Menda, Yusuf

AU - Buatti, John M.

PY - 2004/7/15

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N2 - Purpose The role of neck dissection after radiation therapy ([RT] with or without chemotherapy) for regionally advanced head and neck cancer is controversial. As much as 50% of residual lymphadenopathy after radiation has no viable tumor cells present on histopathologic analysis. [18F] fluorodeoxyglucose positron emission tomography (FDG PET) imaging can detect metabolically active cancer. This study examines the ability of post-RT FDG PET imaging to predict the tumor status of residual lymphadenopathy after nonsurgical management of regionally advanced neck disease. Methods and material From February 2000 to October 2002, 41 patients were treated definitively by radiation (with or without chemotherapy) and underwent FDG PET and computed tomography (CT) imaging after treatment to assess response. Patients with negative CT and FDG PET scans were observed and did not undergo neck dissection. Patients with radiographically persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration of the lymph nodes using ultrasound guidance. The results of the FDG PET scans were correlated with the pathologic findings. Results Twelve patients with persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration. Four of the 12 were found to have viable residual tumor in the cervical lymph nodes. The pathology did not correlate with the size of the lymph nodes in the pre-RT or post-RT CT studies. However, the pathology correlated strongly with the post-RT FDG PET studies. All patients with a negative post-RT FDG PET or those with a maximum standardized uptake value (SUVmax) of less than 3.0 in the post-RT FDG PET were found to be free of residual viable tumor. Using an SUVmax of less than 3.0 as the criterion for a negative FDG PET study, the negative predictive value was 100% and the positive predictive value was 80%. Conclusions A negative post-RT FDG PET scan is very predictive of negative pathology in neck dissection or fine-needle aspiration even with large residual lymphadenopathy. Therefore, if the post-RT FDG PET scan is negative, neck dissection might not be required for regional control. A prospective study with longer follow-up and greater patient numbers is needed to determine whether a policy of deferring neck dissection based on a negative FDG PET is supported.

AB - Purpose The role of neck dissection after radiation therapy ([RT] with or without chemotherapy) for regionally advanced head and neck cancer is controversial. As much as 50% of residual lymphadenopathy after radiation has no viable tumor cells present on histopathologic analysis. [18F] fluorodeoxyglucose positron emission tomography (FDG PET) imaging can detect metabolically active cancer. This study examines the ability of post-RT FDG PET imaging to predict the tumor status of residual lymphadenopathy after nonsurgical management of regionally advanced neck disease. Methods and material From February 2000 to October 2002, 41 patients were treated definitively by radiation (with or without chemotherapy) and underwent FDG PET and computed tomography (CT) imaging after treatment to assess response. Patients with negative CT and FDG PET scans were observed and did not undergo neck dissection. Patients with radiographically persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration of the lymph nodes using ultrasound guidance. The results of the FDG PET scans were correlated with the pathologic findings. Results Twelve patients with persistent lymphadenopathy underwent either neck dissection or fine-needle aspiration. Four of the 12 were found to have viable residual tumor in the cervical lymph nodes. The pathology did not correlate with the size of the lymph nodes in the pre-RT or post-RT CT studies. However, the pathology correlated strongly with the post-RT FDG PET studies. All patients with a negative post-RT FDG PET or those with a maximum standardized uptake value (SUVmax) of less than 3.0 in the post-RT FDG PET were found to be free of residual viable tumor. Using an SUVmax of less than 3.0 as the criterion for a negative FDG PET study, the negative predictive value was 100% and the positive predictive value was 80%. Conclusions A negative post-RT FDG PET scan is very predictive of negative pathology in neck dissection or fine-needle aspiration even with large residual lymphadenopathy. Therefore, if the post-RT FDG PET scan is negative, neck dissection might not be required for regional control. A prospective study with longer follow-up and greater patient numbers is needed to determine whether a policy of deferring neck dissection based on a negative FDG PET is supported.

KW - FDG PET

KW - Head and neck cancer

KW - Neck dissection

KW - Radiation

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