title: 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.
abstract: 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.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine.
authors.forename: V A
authors.initials: VA
authors.lastname: Passero
authors.affiliation: Department of Radiology; Department of Otolaryngology.
authors.forename: B F
authors.initials: BF
authors.lastname: Branstetter
authors.affiliation: The University of Pittsburgh Cancer Institute Biostatistics Facility.
authors.forename: Y
authors.initials: Y
authors.lastname: Shuai
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh and Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Heron
authors.affiliation: Division of Hematology-Oncology, Department of Medicine.
authors.forename: M K
authors.initials: MK
authors.lastname: Gibson
authors.affiliation: Department of Otolaryngology.
authors.forename: S Y
authors.initials: SY
authors.lastname: Lai
authors.affiliation: Department of Otolaryngology.
authors.forename: S W
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology.
authors.forename: J R
authors.initials: JR
authors.lastname: Grandis
authors.affiliation: Department of Otolaryngology.
authors.forename: R L
authors.initials: RL
authors.lastname: Ferris
authors.affiliation: Department of Otolaryngology.
authors.forename: J T
authors.initials: JT
authors.lastname: Johnson
authors.affiliation: Division of Hematology-Oncology, Department of Medicine; Department of Otolaryngology. Electronic address: argirisae@upmc.edu.
authors.forename: A
authors.initials: A
authors.lastname: Argiris
mesh_terms: 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
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18