Response assessment by combined PET-CT scan versus CT scan alone using RECIST in patients with locally advanced head and neck cancer treated with chemoradiotherapy.
OBJECTIVE
RECIST have limitations when applied to potentially curable locally advanced squamous cell carcinoma of the head and neck (SCCHN). [¹⁸F]fluorodeoxyglucose-positron emission tomography (PET) scan may be useful in assessing treatment response and predicting patient outcome.


METHODS
We studied patients with previously untreated stages III-IVb SCCHN treated with primary concurrent chemoradiotherapy on five prospective clinical trials. Response was assessed by clinical exam, computed tomography (CT), and PET portions of combined PET-CT scan ∼8 weeks after completion of chemoradiotherapy.


RESULTS
Fifty-three patients were analyzed. Complete response (CR) was demonstrated in 42 patients (79%) by clinical exam, 15 (28%) by CT, and 27 (51%) by PET. CR as assessed by PET, but not as assessed by clinical exam or CT using RECIST, correlated significantly with progression-free status (PFS) (P < 0.0001). The 2-year PFS for patients with CR and without CR by PET was 93% and 48%, respectively (P = 0.0002).


CONCLUSIONS
A negative PET scan on combined PET-CT after chemoradiotherapy is a powerful predictor of outcome in patients receiving curative chemoradiotherapy for SCCHN. PET-CT is indicated for response evaluation in this setting to improve the accuracy of post-treatment assessment by CT.
Passero
V A
VA
Division of Hematology-Oncology, Department of Medicine.
Branstetter
B F
BF
Department of Radiology; Department of Otolaryngology.
Shuai
Y
Y
The University of Pittsburgh Cancer Institute Biostatistics Facility.
Heron
D E
DE
Department of Radiation Oncology, University of Pittsburgh and Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
Gibson
M K
MK
Division of Hematology-Oncology, Department of Medicine.
Lai
S Y
SY
Department of Otolaryngology.
Kim
S W
SW
Department of Otolaryngology.
Grandis
J R
JR
Department of Otolaryngology.
Ferris
R L
RL
Department of Otolaryngology.
Johnson
J T
JT
Department of Otolaryngology.
Argiris
A
A
Division of Hematology-Oncology, Department of Medicine; Department of Otolaryngology. Electronic address: argirisae@upmc.edu.
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18