Technology insight: PET and PET/CT in head and neck tumor staging and radiation therapy planning.
The evolving utilization of functional imaging, mainly 2-[18F]fluoro-2-deoxyglucose (18FDG) imaging, with positron emission tomography (PET) and PET/CT, is profoundly altering head and neck tumor staging approaches, radiation treatment planning, and follow-up management. Tumor-node-metastasis staging with PET/CT has improved the characterization of patient disease versus CT, MRI, or PET alone, thereby affecting patient disease management. Therefore, the utilization of PET/CT is appropriate for head and neck cancer staging in the initial presentation and in the recurrent setting. In the setting of radiation therapy treatment planning, PET-directed tumor volume contouring is not ready for clinical practice without further technological improvements in imaging specificity/sensitivity and resolution. Patient or organ motion might interfere with the accuracy of anatomical co-alignment, and variability in defining the threshold of imaging signals on PET images can affect the contour of the biological tumor volume. The use of PET/CT for staging and detecting both primary and recurrent head and neck cancer is valuable; however, its application in radiation treatment planning should be viewed as investigational.
Frank
Steven J
SJ
University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Chao
K S Clifford
KS
Schwartz
David L
DL
Weber
Randal S
RS
Apisarnthanarax
Smith
S
Macapinlac
Homer A
HA
D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome