Impact of PET/CT on Staging and Treatment of Advanced Head and Neck Squamous Cell Carcinoma

Abstract

Objective To understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. Study Design Prospective blinded study. Setting Tertiary care cancer center. Subjects and Methods Informed consent was obtained and data collected from 52 consecutive previously untreated patients with HNSCC and clinical evidence of cervical metastasis. All patients underwent conventional evaluation for HNSCC and whole body PET/CT. Data were evaluated by 5 independent reviewers, who performed TNM staging per the American Joint Committee on Cancer (seventh edition) manual and proposed a treatment plan prior to viewing, and after reviewing, PET/CT. Cases where at least 3 of 5 reviewers agreed were considered significant. Results There were 0 patients for whom review of the PET/CT altered the T-class assessment (95% CI, 0-6.8), 12 (23.1%) for whom PET/CT altered N classification (95% CI, 12.5-34.5), and 2 (3.8%) for whom PET/CT altered the M classification (95% CI, 0.5-13.2). For 5 patients (9.6%), overall stage was altered per PET/CT review (95% CI, 3.2-21). For 3 patients (5.8%), PET/CT findings prompted reviewers to alter treatment recommendations (95% CI, 1.2-15.9). Conclusion When added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.

Routine panendoscopy in oral squamous cell cancer patients: mandatory or facultative?

“…The yield of panendoscopy was 0.5% for invasive cancers over radiologic imaging. This corroborates findings of similar low yield in earlier studies [23,[42][43][44]. Non-smokers and non-drinkers are significantly less likely to have therapeutic consequences from routine panendoscopy.…”

Impact of pretreatment second look 18FDG-PET/CT on stage and treatment changes in head and neck cancer

“…Additionally, MRI is substantially hampered by dental artifacts, which is quite relevant for the visualization of the oral cavity and some oropharyngeal tumors. Moreover, according to our experience, dedicated highresolution PET/CT of the head and neck region appears at least noninferior or even superior to MRI and CT for the detection of pathologically involved lymph nodes and distant metastases and helps to detect second primary malignancies [9,10,19,[11][12][13][14][15][16][17][18]. On the other hand, the anatomical resolution, tissue contrast and availability of different functional imaging sequences make MRI the superior modality for the identification and demarcation of primary tumors [20].…”

PET/CTversus triple endoscopy in initial workup ofHPV+ oropharyngeal squamous cell carcinoma

“…PET/CT can alter TNM staging and, subsequently, treatment planning. 23,24 While expensive as a single modality, PET/CT in HNSCC reduces longterm overall health care and personal costs compared to conventional workup. [8][9][10][11]25 Furthermore, PET/CT has greater sensitivity and negative predictive value in detecting SPTs in HNSCC compared to triple endoscopy.…”

“…PET/CT has a diverse role in HNSCC, including: detection of SPTs, distant metastases and unknown primaries; measuring treatment response; and detection of recurrent disease. PET/CT can alter TNM staging and, subsequently, treatment planning 23,24 . While expensive as a single modality, PET/CT in HNSCC reduces long‐term overall health care and personal costs compared to conventional workup 8–11,25 .…”