title: Can "early" and "late"18F-FDG PET-CT be used as prognostic factors for the clinical outcome of patients with locally advanced head and neck cancer treated with radio-chemotherapy?
abstract: OBJECTIVE
  To evaluate the prognostic value of "early" and "late" Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) in patients with head and neck squamous cell carcinoma (HNSCC) treated with radio-chemotherapy (RTCT).
  
  
  METHODS
  Twenty-six patients treated with RTCT for HNSCC were included. All patients underwent (18)F-FDG PET-CT at baseline ("staging" PET-CT), after 2 weeks of treatment ("early" PET-CT) and 8-12 weeks after treatment ("late" PET-CT). Changes in FDG uptake in the primary tumor (T) and lymph nodes (N) were correlated with local and regional control, respectively; overall metabolic response was correlated with relapse free survival (RFS) and disease specific survival (DSS).
  
  
  RESULTS
  After a median follow-up of 29.2 months, 19/26 patients were living and 17/19 had no evidence of disease. When comparing "staging", "early" and "late" PET results, a significant decrease of FDG SUV(max) in T and N was documented. When correlating changes in FDG uptake in T and N with local and regional control, a statistically significant correlation only with the "late" reduction was found. Statistical analysis failed to demonstrate any correlation between the "early" metabolic response and the patient clinical outcome while the "late" metabolic response revealed a strong correlation with RFS (p = 0.01) and DSS (p = 0.009).
  
  
  CONCLUSIONS
  In patients with HNSCC, PET-CT performed after RTCT predicts the clinical outcome, since it strongly correlates with RFS and DSS. On the other hand, the predictive role of "early" metabolic response was not confirmed by this study.
authors.affiliation: Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Castaldi
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rufini
authors.forename: Francesco
authors.initials: F
authors.lastname: Bussu
authors.forename: Francesco
authors.initials: F
authors.lastname: Miccichè
authors.forename: Nicola
authors.initials: N
authors.lastname: Dinapoli
authors.forename: Rosa
authors.initials: R
authors.lastname: Autorino
authors.forename: Mariaelena
authors.initials: M
authors.lastname: Lago
authors.forename: Eugenio
authors.initials: E
authors.lastname: De Corso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Almadori
authors.forename: Jacopo
authors.initials: J
authors.lastname: Galli
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paludetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011379:Prognosis; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18