Early metabolic 18F-FDG PET/CT response of locally advanced squamous-cell carcinoma of head and neck to induction chemotherapy: A prospective pilot study

Abstract

ObjectiveThe objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN).Methods and findingsA prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA–B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056–0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040–0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062–0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013–0.96; p = 0.046) survival.ConclusionsThese results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes.

Diagnostic accuracy and prognostic applications of CYFRA 21-1 in head and neck cancer: A systematic review and meta-analysis

“…Until now, the major treatments for most patients with HNC include radiotherapy alone or in combination with chemotherapy, but local recurrence still remains the main reason for treatment failure in this group of patients. About 50% of patients have local recurrence after primary tumor resection, and despite active treatment, 25% of them develop distant metastases[14–18]. Therefore, early diagnosis and precise prognosis of patients with HNC are critical and urgently required.…”

Virus Papiloma Humano. Un enemigo silencioso en el Ecuador y el mundo

“…Desde las civilizaciones greco-romanas los Virus del Papiloma (VP) (36) se identificaron como causa de infección a través de la formación de verrugas; pero no fue hasta 1900 que la etiología de estas fue confirmada. A partir de ese momento, se identificaron VP en varias especies de vertebrados, incluyendo los humanos (37,38).…”

Quality Assessment in FDG-PET/CT Imaging of Head-and-Neck Cancer: One Home Run Is Better Than Two Doubles

“…This has prompted interest in using FDG-PET/CT earlier during treatment to identify patients who may not respond. For example, a recent study suggested that FDG-PET/CT performed 14 days after the start of neo-adjuvant chemotherapy in patients with locally advanced disease was able to identify patients with poor outcomes, based on an increase in regional lymph node maximum SUV and insufficient decrease in primary tumor uptake after 2 weeks of treatment ( 47 ). Currently, the PERCIST thresholds (decrease ≥30%) do not vary according to the number of treatment cycles received (i.e., mid-treatment or end-of-treatment), which may change in subsequent versions ( 48 ).…”