title: Early prediction of response to chemoradiotherapy for head and neck cancer: reliability of restaging with combined positron emission tomography and computed tomography.
abstract: OBJECTIVE
  To assess the role of combined positron emission tomography and computed tomography (PET-CT) in predicting early treatment response at the primary site and in the neck after chemoradiotherapy (CRT) for advanced squamous cell carcinoma of the head and neck (SCCHN).
  
  
  METHODS
  Retrospective analysis with a median follow-up of 24 months.
  
  
  METHODS
  Academic, tertiary referral center.
  
  
  METHODS
  Thirty-one patients who were treated with concomitant intra-arterial CRT underwent PET-CT 6 to 8 weeks after the completion of treatment. Patients with findings on the physical examination, CT, or PET-CT indicative of persistent disease underwent appropriate surgical intervention for pathological assessment. Patients with a complete clinical response were observed with routine follow-up physical examination for disease recurrence. No evidence of disease at least 6 months after the completion of PET-CT was considered confirmation of complete clinical response.
  
  
  METHODS
  Presence or absence of residual or recurrent disease during the follow-up period was used to calculate the sensitivity, specificity, and positive and negative predictive values of PET-CT for the primary site and the neck.
  
  
  RESULTS
  Assessment of tumor response at the primary site with PET-CT had a sensitivity, specificity, and positive and negative predictive values of 83%, 54%, 31%, and 92%, respectively. In patients with pretreatment N1 to N3 disease, the sensitivity, specificity, and positive and negative predictive values of posttreatment PET-CT were 75%, more than 94%, more than 75%, and 94%, respectively, and the specificity and negative predictive value for patients with pretreatment N0 disease in the neck were 92% and more than 92%, respectively.
  
  
  CONCLUSIONS
  Negative PET-CT findings accurately determine early disease response at the primary site and in the neck. False-positive findings are common at the primary site. Patients with a negative PET-CT finding after the completion of intra-arterial CRT do not require surgical intervention.
authors.affiliation: Department of Surgery, Southern Illinois School of Medicine, Springfield, IL 62794-9649, USA. jmalone@siumed.edu
authors.forename: James P
authors.initials: JP
authors.lastname: Malone
authors.forename: Michael A T
authors.initials: MA
authors.lastname: Gerberi
authors.forename: Syam
authors.initials: S
authors.lastname: Vasireddy
authors.forename: Larry F
authors.initials: LF
authors.lastname: Hughes
authors.forename: Krishna
authors.initials: K
authors.lastname: Rao
authors.forename: Bruce
authors.initials: B
authors.lastname: Shevlin
authors.forename: Matthew
authors.initials: M
authors.lastname: Kuhn
authors.forename: Dean
authors.initials: D
authors.lastname: Collette
authors.forename: Joel
authors.initials: J
authors.lastname: Tennenhouse
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents