Value of FDG PET in assessment of treatment response and surveillance in head-and-neck cancer patients after intensity modulated radiation treatment

A preliminary report

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

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

[18F] fluorodeoxyglucose positron emission tomography (FDG PET) imaging has been shown to be valuable in early detection of persistent and recurrent head-and-neck cancer after treatment. Previous studies have reported its use in patients treated with conventional radiation. Many patients are now treated with intensity-modulated radiation treatment (IMRT). We evaluated the value of FDG PET in the assessment of treatment response and surveillance in head-and-neck cancer patients treated with IMRT. We performed a retrospective review of 85 head-and-neck cancer patients treated with IMRT at our institution between December 2000 and September 2003 who had FDG PET in their follow-up. Of these, 58 were treated with primary IMRT with or without chemotherapy, and 27 were treated with postoperative IMRT. Sixty-four patients had negative initial FDG PET after treatment. Forty of them, who had 6 to 24 months of follow-up after the imaging study, had no evidence of local or regional recurrence, although three of them developed distant disease. Twenty-one patients had a positive initial FDG PET after treatment, with 11 positive at the primary site, 9 positive in the neck, and 3 positive distantly. Six of 11 patients with a positive FDG PET at the primary site were true positive, and 3 had salvage surgery. Eight of 9 patients positive in the neck had a salvage neck dissection. One had fine needle aspiration of the lymph node with positive cytology but refused surgery later. For patients with follow-up of 6 months and longer, only 1 of 45 patients with a negative initial FDG PET at the primary site developed a local recurrence. None of 49 patients with a negative initial FDG PET in the neck developed a regional recurrence. Two cases are presented in which abnormal FDG PET preceded laryngoscopy or computed tomography in detection of tumor recurrences. FDG PET is useful in the posttreatment management of head-and-neck cancer patients treated with IMRT. It is highly accurate in the detection of persistent and recurrent disease after treatment and allows salvage treatment to be initiated in a timely manner. It also provides prognostic information concerning the risk of recurrence after curative therapy.

Original languageEnglish (US)
Pages (from-to)1410-1418
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume60
Issue number5
DOIs
StatePublished - Dec 1 2004

Fingerprint

Head and Neck Neoplasms
surveillance
Positron-Emission Tomography
positrons
tomography
cancer
Radiation
radiation
Recurrence
Therapeutics
Neck
surgery
cytology
Salvage Therapy
dissection
Laryngoscopy
Neck Dissection
lymphatic system
Fluorodeoxyglucose F18
chemotherapy

Keywords

  • FDG PET
  • Head-and-neck cancer
  • Intensity-modulated radiation treatment
  • Surveillance
  • Treatment response

ASJC Scopus subject areas

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

Cite this

Value of FDG PET in assessment of treatment response and surveillance in head-and-neck cancer patients after intensity modulated radiation treatment : A preliminary report. / Yao, Min; Graham, Michael M.; Smith, Russell B; Dornfeld, Kenneth J.; Skwarchuk, Mark; Hoffman, Henry T.; Funk, Gerry F.; Graham, Scott M.; Menda, Yusuf; Buatti, John M.

In: International Journal of Radiation Oncology Biology Physics, Vol. 60, No. 5, 01.12.2004, p. 1410-1418.

Research output: Contribution to journalArticle

Yao, Min ; Graham, Michael M. ; Smith, Russell B ; Dornfeld, Kenneth J. ; Skwarchuk, Mark ; Hoffman, Henry T. ; Funk, Gerry F. ; Graham, Scott M. ; Menda, Yusuf ; Buatti, John M. / Value of FDG PET in assessment of treatment response and surveillance in head-and-neck cancer patients after intensity modulated radiation treatment : A preliminary report. In: International Journal of Radiation Oncology Biology Physics. 2004 ; Vol. 60, No. 5. pp. 1410-1418.
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AB - [18F] fluorodeoxyglucose positron emission tomography (FDG PET) imaging has been shown to be valuable in early detection of persistent and recurrent head-and-neck cancer after treatment. Previous studies have reported its use in patients treated with conventional radiation. Many patients are now treated with intensity-modulated radiation treatment (IMRT). We evaluated the value of FDG PET in the assessment of treatment response and surveillance in head-and-neck cancer patients treated with IMRT. We performed a retrospective review of 85 head-and-neck cancer patients treated with IMRT at our institution between December 2000 and September 2003 who had FDG PET in their follow-up. Of these, 58 were treated with primary IMRT with or without chemotherapy, and 27 were treated with postoperative IMRT. Sixty-four patients had negative initial FDG PET after treatment. Forty of them, who had 6 to 24 months of follow-up after the imaging study, had no evidence of local or regional recurrence, although three of them developed distant disease. Twenty-one patients had a positive initial FDG PET after treatment, with 11 positive at the primary site, 9 positive in the neck, and 3 positive distantly. Six of 11 patients with a positive FDG PET at the primary site were true positive, and 3 had salvage surgery. Eight of 9 patients positive in the neck had a salvage neck dissection. One had fine needle aspiration of the lymph node with positive cytology but refused surgery later. For patients with follow-up of 6 months and longer, only 1 of 45 patients with a negative initial FDG PET at the primary site developed a local recurrence. None of 49 patients with a negative initial FDG PET in the neck developed a regional recurrence. Two cases are presented in which abnormal FDG PET preceded laryngoscopy or computed tomography in detection of tumor recurrences. FDG PET is useful in the posttreatment management of head-and-neck cancer patients treated with IMRT. It is highly accurate in the detection of persistent and recurrent disease after treatment and allows salvage treatment to be initiated in a timely manner. It also provides prognostic information concerning the risk of recurrence after curative therapy.

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