Positron emission tomography–CT prediction of occult nodal metastasis in recurrent laryngeal cancer

Rosko, Andrew J.; Birkeland, Andrew C.; Shuman, Andrew G.; Prince, Mark; Bradford, Carol R.; Wolf, Gregory T.; Worden, Francis P.; Eisbruch, Avraham; Srinivasan, Ashok; Wong, Ka Kit; Spector, Matthew E.

doi:10.1002/hed.24719

Cited by 19 publications

(14 citation statements)

References 45 publications

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“…These cases carry a high risk of occult metastases (T1: 9%; T2: 10%; T3: 16%; T4 34%; supraglottic T1-4 28%, supraglottic T4: 50%) [ 77 ]. Even the risk of occult metastases in clinically unsuspicious cervical lymph nodes seems to be much lower after primary R(C)T, selective neck dissection (levels IIa, III, IV) is usually included in the salvage procedure [ 78 ], since PET-CT seems to have a poor sensitivity in this situation [ 79 ]. In general, salvage laryngectomy is usually performed within two years of the primary RCT [ 47 ].…”

Section: Adjuvantsmentioning

confidence: 99%

Total Laryngectomy—Still Cutting-Edge?

Hoffmann

2021

Cancers

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Surgical removal of the larynx (total laryngectomy) offers a curative approach to patients with advanced laryngeal and hypopharyngeal (squamous cell) cancer without distant metastases. Particularly in T4a carcinoma, laryngectomy seems prognostically superior to primary radio(chemo)therapy. Further relevant indications for laryngectomy include massive laryngeal dysfunction associated with aspiration and recurrence after radio(chemo)therapy, resulting in salvage surgery. The surgical procedure including neck dissection is highly standardised and safe. The resulting aphonia can be compensated by functional rehabilitation (e.g., voice prosthesis) associated with a significant quality of life improvement. This article presents an overview of indications, preoperative diagnostics, surgical procedures, including new developments (robotics), possible complications, the choice of adjuvant treatment, alternative therapeutic approaches, rehabilitation and prognosis. In summary, total laryngectomy still represents a relevant surgical procedure in modern head and neck oncology.

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Section: Adjuvantsmentioning

confidence: 99%

Total Laryngectomy—Still Cutting-Edge?

Hoffmann

2021

Cancers

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“…If, based on the [18F]FDG-PET-CT result, the ND in patients with an uncertain or positive neck response in contrast CT had been omitted, the treatment of persistent nodal disease would have been delayed in 3 of 13 patients. On the other hand, if ND would have only been Table 5 Diagnostic accuracy of PET-CT in post-RCT necks with histopathology defined as reference criterion in previously published studies [25][26][27][28][29] Author ( a time interval in weeks between end of primary treatment and PET-CT. Range, means or medians were provided if reported; b negative predictive value; c n.a.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast to histopathological results of post-RCT ND specimens, the further course of disease hardly allows to differentiate between persistent and recurrent neck disease and may be biased by loss to follow up. We identified several studies, which had also used the histopathological outcome of post-RCT ND specimens as reference criterion [16,[25][26][27][28] (Table 5) [28]. However, all these studies did not use prevalence data in their analysis [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

“…c (median 12.6) 20 85.7% Kim (2011) [ 26 ] various 8–28 (n.a. c ) 39 92.0% Pellini (2014) [ 27 ] oropharyngeal 3–6 (median 4) 36 64.3% Rosko (2017) [ 28 ] laryngeal 6–26 (median 13.3) 46 76.7% a time interval in weeks between end of primary treatment and PET-CT. Range, means or medians were provided if reported; b negative predictive value; c n.a.…”

Section: Discussionmentioning

confidence: 99%

“…[18F]FDG-PET-CTs were performed 6 to 26 weeks after completion of primary treatment. The authors observed a NPV of 76.6% for [18F]FDG-PET-CT [ 28 ]. However, all these studies did not use prevalence data in their analysis [ 25 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Response evaluation of cervical lymph nodes after chemoradiation in patients with head and neck cancer - does additional [18F]FDG-PET-CT help?

et al. 2020

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Background Contrast-enhanced high-resolution computed tomography (contrast-CT) is a standard imaging modality following primary concurrent radiochemotherapy (RCT) for response evaluation in patients with head and neck squamous cell carcinoma (HNSCC). We investigated the additional benefit of Fluorine-18-fluorodeoxyglucose ([18F]FDG) - positron emission tomography with computed tomography (PET-CT), if complete response (CR) in the neck based on contrast-CT was considered unsafe by the interdisciplinary tumor board (ITB). Methods In a retrospective observational study, patients recorded in the institutional tumor registry with incident advanced HNSCC following first line treatment with RCT were eligible. If contrast-CT results of the neck were equivocal or positive at response evaluation, a neck dissection (ND) was scheduled. While waiting for the ND, a [18F]FDG-PET-CT was performed in addition. The histopathological outcome of ND served as reference criterion. Accuracy parameters including sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for both, contrast-CT and PET-CT, served as main outcome parameters. Results A total of 41 HNSCC patients with positive or equivocal posttreatment contrast-CT were eligible for post-RCT-ND. Of these, 33 received an additional [18F]FDG-PET-CT prior to surgery. Median interval between completion of RCT and the ([18F]FDG)-PET-CT was 10 weeks. Vital persistent tumor in the neck was histopathologically found in 13 of 33 patients with positive or equivocal posttreatment contrast-CT. For contrast-CT and [18F]FDG-PET-CT, sensitivity was 92.3 and 69.2% and did not differ statistically significantly (p = 0.250) whereas specificity was significantly higher for [18F]FDG-PET-CT compared with contrast-CT (80% vs. 25%, p = 0.001). For contrast-CT and [18F]FDG-PET-CT accuracy, PPV and NPV was 31.7, 12.0,96.7 and 78.9, 27.8,95.0%, respectively. Conclusion A negative [18F]FDG-PET-CT did not improve the exclusion of persistent vital tumor in the neck after primary RCT in comparison with contrast-CT alone. However, a positive [18F]FDG-PET-CT was a considerably better indicator of persistent, vital tumor in the neck than contrast-CT. If, based on the [18F]FDG-PET-CT result, the ND in patients with an uncertain or positive neck response in contrast CT had been omitted, the treatment of persistent nodal disease would have been delayed in 3 of 13 patients. On the other hand, if ND would have only been performed in [18F]FDG-PET-CT positive patients, an unnecessary ND would have been avoided in 11 of 20 patients.

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Evaluation of the Prognostic Value of FDG PET/CT Parameters for Patients With Surgically Treated Head and Neck Cancer

Creff

Devillers

Depeursinge

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEHead and neck squamous cell cancer (HNSCC) represents the seventh most frequent cancer worldwide. More than half of the patients diagnosed with HNSCC are treated with primary surgery.OBJECTIVE To report the available evidence on the value of quantitative parameters of fluorodeoxyglucose F 18-labeled positron emission tomography and computed tomography (FDG-PET/CT) performed before surgical treatment of HNSCC to estimate overall survival (OS), disease-free survival (DFS), and distant metastasis (DM) and to discuss their limitations.EVIDENCE REVIEW A systematic review of the English-language literature in PubMed/MEDLINE and ScienceDirect published between January 2003 and February 15, 2019, was performed between March 1 and July 27, 2019, to identify articles addressing the association between preoperative FDG-PET/CT parameters and oncological outcomes among patients with HNSCC. Articles included those that addressed the following: (1) cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) surgically treated (primary or for salvage);(3) pretreatment FDG-PET/CT; (4) quantitative or semiquantitative evaluation of the FDG-PET/CT parameters; and (5) the association between the value of FDG-PET/CT parameters and clinical outcomes. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine level of evidence. FINDINGS A total of 128 studies were retrieved from the databases, and 36 studies met the inclusion criteria; these studies comprised 3585 unique patients with a median follow-up of 30.6 months (range, 16-53 months). Of these 36 studies, 32 showed an association between at least 1 FDG-PET/CT parameter and oncological outcomes (OS, DFS, and DM). The FDG-PET/CT volumetric parameters (metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) were independent prognostic factors in most of the data, with a higher prognostic value than the maximum standard uptake value (SUVmax). For example, in univariate analysis of OS, the SUVmax was correlated with OS in 5 of 11 studies, MTV in 11 of 12 studies, and TLG in 6 of 9 studies. The spatial distribution of metabolism via textural indices seemed promising, although that factor is currently poorly evaluated: only 3 studies analyzed data from radiomics indices. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that the prognostic effectiveness of FDG-PET/CT parameters as biomarkers of OS, DFS, and DM among patients with HNSCC treated with surgery may be valuable. The volumetric parameters (MTV and TLG) seemed relevant for identifying patients with a higher risk of postsurgical disease progression who could receive early therapeutic intervention to improve their prognosis. However, further large-scale studies including exclusively surgery-treated patients stratified according to localization and further analysis of the textural indices are required to define a reliable FDG-PET/CT-based prognostic model of mortality and recurrence risk for these patients.

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Positron emission tomography–CT prediction of occult nodal metastasis in recurrent laryngeal cancer

Cited by 19 publications

References 45 publications

Total Laryngectomy—Still Cutting-Edge?

Total Laryngectomy—Still Cutting-Edge?

Response evaluation of cervical lymph nodes after chemoradiation in patients with head and neck cancer - does additional [18F]FDG-PET-CT help?

Evaluation of the Prognostic Value of FDG PET/CT Parameters for Patients With Surgically Treated Head and Neck Cancer

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