title: PET/CT staging followed by Intensity-Modulated Radiotherapy (IMRT) improves treatment outcome of locally advanced pharyngeal carcinoma: a matched-pair comparison.
abstract: BACKGROUND
  Impact of non-pharmacological innovations on cancer cure rates is difficult to assess. It remains unclear, whether outcome improves with 2- [18-F]-fluoro-2-deoxyglucose-positron emission tomography and integrated computer tomography (PET/CT) and intensity-modulated radiotherapy (IMRT) for curative treatment of advanced pharyngeal carcinoma.
  
  
  METHODS
  Forty five patients with stage IVA oro- or hypopharyngeal carcinoma were staged with an integrated PET/CT and treated with definitive chemoradiation with IMRT from 2002 until 2005. To estimate the impact of PET/CT with IMRT on outcome, a case-control analysis on all patients with PET/CT and IMRT was done after matching with eighty six patients treated between 1991 and 2001 without PET/CT and 3D-conformal radiotherapy with respect to gender, age, stage, grade, and tumor location with a ratio of 1:2. Median follow-up was eighteen months (range, 6-49 months) for the PET/CT-IMRT group and twenty eight months (range, 1-168 months) for the controls.
  
  
  RESULTS
  PET/CT and treatment with IMRT improved cure rates compared to patients without PET/CT and IMRT. Overall survival of patients with PET/CT and IMRT was 97% and 91% at 1 and 2 years respectively, compared to 74% and 54% for patients without PET/CT or IMRT (p = 0.002). The event-free survival rate of PET/CT-IMRT group was 90% and 80% at 1 and 2 years respectively, compared to 72% and 56% in the control group (p = 0.005).
  
  
  CONCLUSIONS
  PET/CT in combination with IMRT and chemotherapy for pharyngeal carcinoma improve oncological therapy of pharyngeal carcinomas. Long-term follow-up is needed to confirm these findings.
authors.affiliation: Center for Clinical Research, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland. s.rothschild@swissonline.ch
authors.forename: Sacha
authors.initials: S
authors.lastname: Rothschild
authors.forename: Gabriela
authors.initials: G
authors.lastname: Studer
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Pia
authors.initials: P
authors.lastname: Huguenin
authors.forename: Christoph
authors.initials: C
authors.lastname: Glanzmann
authors.forename: J Bernard
authors.initials: JB
authors.lastname: Davis
authors.forename: Urs M
authors.initials: UM
authors.lastname: Lütolf
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hany
authors.forename: I Frank
authors.initials: IF
authors.lastname: Ciernik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000532:radiotherapy*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D049268:Positron-Emission Tomography / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome