title: Early detection of recurrent disease by FDG-PET/CT leads to management changes in patients with squamous cell cancer of the head and neck.
abstract: OBJECTIVE
  The objective of this study was to compare the efficacy of surveillance high-resolution computed tomography (HRCT) and physical examination/endoscopy (PE/E) with the efficacy of fluorodeoxyglucose (FDG)-positron emission tomography (PET)/HRCT for the detection of relapse in head and neck squamous cell carcinoma (HNSCC) after primary treatment.
  
  
  METHODS
  This is a retrospective analysis of contemporaneously performed FDG-PET/HRCT, neck HRCT, and PE/E in 99 curatively treated patients with HNSCC during post-therapy surveillance to compare performance test characteristics in the detection of early recurrence or second primary cancer.
  
  
  RESULTS
  Relapse occurred in 19 of 99 patients (20%) during a median follow-up of 21 months (range: 9-52 months). Median time to first PET/HRCT was 3.5 months. The median time to radiological recurrence was 6 months (range: 2.3-32 months). FDG-PET/HRCT detected more disease recurrences or second primary cancers and did so earlier than HRCT or PE/E. The sensitivity, specificity, and positive and negative predictive values for detecting locoregional and distant recurrence or second primary cancer were 100%, 87.3%, 56.5%, and 100%, respectively, for PET/HRCT versus 61.5%, 94.9%, 66.7%, and 93.8%, respectively, for HRCT versus 23.1%, 98.7%, 75%, and 88.6%, respectively, for PE/E. In 19 patients with true positive PET/HRCT findings, a significant change in the management of disease occurred, prompting either salvage or systemic therapy. Of the 14 curatively treated patients, 11 were alive with without disease at a median follow-up of 31.5 months.
  
  
  CONCLUSIONS
  FDG-PET/HRCT has a high sensitivity in the early detection of relapse or second primary cancer in patients with HNSCC, with significant management implications. Given improvements in therapy and changes in HNSCC biology, appropriate modifications in current post-therapy surveillance may be required to determine effective salvage or definitive therapies.
authors.affiliation: From the Departments of Radiology.
authors.forename: Lale
authors.initials: L
authors.lastname: Kostakoglu
authors.forename: Reza
authors.initials: R
authors.lastname: Fardanesh
authors.forename: Marshall
authors.initials: M
authors.lastname: Posner
authors.forename: Peter
authors.initials: P
authors.lastname: Som
authors.forename: Srikar
authors.initials: S
authors.lastname: Rao
authors.forename: Eunice
authors.initials: E
authors.lastname: Park
authors.forename: John
authors.initials: J
authors.lastname: Doucette
authors.forename: Evan G
authors.initials: EG
authors.lastname: Stein
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Misiukiewicz
authors.forename: Eric
authors.initials: E
authors.lastname: Genden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D004724:Endoscopy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D011859:Radiography; D016019:Survival Analysis
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Head and neck cancer; PET/CT; Surveillance and survival
references.citation: Acta Otolaryngol. 2009 Aug;129(8):893-9
references.pmid: 18839385
references.citation: Laryngoscope. 2012 Jul;122(7):1512-7
references.pmid: 22685038
references.citation: Laryngoscope. 2012 Feb;122(2):311-4
references.pmid: 22252963
references.citation: Semin Radiat Oncol. 2012 Apr;22(2):108-18
references.pmid: 22385918
references.citation: Nat Rev Cancer. 2011 Jan;11(1):9-22
references.pmid: 21160525
references.citation: Lancet Oncol. 2011 Apr;12(4):333-43
references.pmid: 21377930
references.citation: Head Neck. 2004 Oct;26(10):890-6
references.pmid: 15390197
references.citation: Br J Radiol. 1997 Apr;70(832):360-6
references.pmid: 9166071
references.citation: Head Neck. 2005 Mar;27(3):175-81
references.pmid: 15627258
references.citation: J Clin Oncol. 2009 May 20;27(15):2509-15
references.pmid: 19332725
references.citation: J Clin Oncol. 2002 Oct 15;20(20):4199-208
references.pmid: 12377963
references.citation: Eur J Radiol. 2008 Jun;66(3):501-11
references.pmid: 18328660
references.citation: J Clin Oncol. 2000 Feb;18(3):651-8
references.pmid: 10653881
references.citation: Head Neck. 2003 Oct;25(10):791-8
references.pmid: 12966502
references.citation: Br J Radiol. 2012 Nov;85(1019):e1120-6
references.pmid: 22744325
references.citation: J Nucl Med. 2008 Apr;49(4):532-40
references.pmid: 18344440
references.citation: Front Pharmacol. 2012 Jul 30;3:149
references.pmid: 23060791
references.citation: Eur J Cancer. 1992;28(2-3):426-30
references.pmid: 1591057
references.citation: Radiother Oncol. 2003 Mar;66(3):323-6
references.pmid: 12742272
references.citation: Clin Otolaryngol. 2008 Jun;33(3):210-22
references.pmid: 18559026
references.citation: N Engl J Med. 1993 Jan 21;328(3):184-94
references.pmid: 8417385
references.citation: Eur J Nucl Med Mol Imaging. 2011 Nov;38(11):2083-95
references.pmid: 21853309
references.citation: Arch Otolaryngol Head Neck Surg. 2011 Nov;137(11):1106-11
references.pmid: 22106234
references.citation: Head Neck. 2011 Dec;33(12):1675-82
references.pmid: 22076976
references.citation: Nucl Med Commun. 2013 Feb;34(2):162-7
references.pmid: 23196675
references.citation: Laryngoscope. 2000 Mar;110(3 Pt 2 Suppl 93):1-18
references.pmid: 10714711
references.citation: Semin Radiat Oncol. 2009 Jan;19(1):17-23
references.pmid: 19028341
references.citation: Head Neck. 2001 Nov;23(11):933-41
references.pmid: 11754496
references.citation: Cancer. 2013 Apr 1;119(7):1349-56
references.pmid: 23225544
references.citation: Br J Oral Maxillofac Surg. 2006 Oct;44(5):371-6
references.pmid: 16624459
references.citation: Head Neck. 2004 May;26(5):447-55
references.pmid: 15122662
references.citation: Laryngoscope. 2005 Apr;115(4):645-50
references.pmid: 15805874
references.citation: Laryngoscope. 2006 May;116(5):705-10
references.pmid: 16652075
references.citation: Oncologist. 2005 Jun-Jul;10(6):370-81
references.pmid: 15967831
references.citation: Arch Otolaryngol Head Neck Surg. 1999 Apr;125(4):379-82
references.pmid: 10208674
references.citation: J Nucl Med. 2009 Jan;50(1):24-9
references.pmid: 19091901
references.citation: Head Neck. 1997 Oct;19(7):559-66
references.pmid: 9323143
references.citation: Radiat Oncol J. 2011 Dec;29(4):243-51
references.pmid: 22984677
references.citation: Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):359-66
references.pmid: 10487556
references.citation: N Engl J Med. 2008 Sep 11;359(11):1116-27
references.pmid: 18784101
references.citation: Arch Surg. 1979 Jan;114(1):39-42
references.pmid: 758876
references.citation: Radiology. 2005 May;235(2):580-6
references.pmid: 15858097
references.citation: Arch Otolaryngol Head Neck Surg. 1994 Sep;120(9):934-9
references.pmid: 8074820
references.citation: Head Neck. 2009 Apr;31(4):442-51
references.pmid: 19177422
references.citation: Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1418-23
references.pmid: 15050318
references.citation: Eur Arch Otorhinolaryngol. 2007 May;264(5):531-8
references.pmid: 17203307
references.citation: Clin Cancer Res. 2004 Mar 15;10(6):1956-62
references.pmid: 15041712
references.citation: Oral Oncol. 2007 Aug;43(7):686-92
references.pmid: 17112775
references.citation: Radiology. 1994 Oct;193(1):149-54
references.pmid: 8090883
references.citation: Radiother Oncol. 2012 Apr;103(1):63-8
references.pmid: 22459579
references.citation: ISRN Oncol. 2012;2012:163752
references.pmid: 22745915
references.citation: Eur J Nucl Med Mol Imaging. 2012 Dec;39(12):1839-47
references.pmid: 22895863
references.citation: J Clin Oncol. 2010 Jan 1;28(1):21-8
references.pmid: 19917865
references.citation: Head Neck. 2006 Jun;28(6):487-95
references.pmid: 16619274
references.citation: Radiol Med. 1997 Dec;94(6):600-6
references.pmid: 9524596
references.citation: Int J Radiat Oncol Biol Phys. 2009 May 1;74(1):9-14
references.pmid: 18930358
references.citation: Head Neck. 2012 May;34(5):727-35
references.pmid: 21484925
references.citation: Radiology. 2004 Apr;231(1):65-72
references.pmid: 14990824
references.citation: Head Neck. 2003 Dec;25(12):990-9
references.pmid: 14648857