Predictive accuracy of first post‐treatment PET/CT in HPV‐related oropharyngeal squamous cell carcinoma

Koshkareva, Yekaterina; Branstetter, Barton F.; Gaughan, John; Ferris, Robert L.

doi:10.1002/lary.24617

Cited by 46 publications

(55 citation statements)

References 21 publications

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“…Most would use a schedule of every 3 months initially, with increasing intervals between scans in subsequent years. [18][19][20][21][22][23][24][25][26][27] In a metaanalysis comprising of 51 studies, Gupta et al 28 reported that the negative predictive value of a negative posttreatment PET scan is high at 95%. 14, 15 Thompson et al, 16 in a study of patients with lymphoma, suggested that surveillance imaging can exacerbate patients' anxiety.…”

Section: Discussionmentioning

confidence: 99%

“…13 There is evidence that frequent surveillance imaging may not affect patient outcomes. 20,21,[23][24][25][26] Therefore, PET imaging potentially can be used as a modality to further stratify surveillance imaging intensity for patients. Also, a recent survey of 175 patients with HNC at 1-year posttreatment follow-up in Ontario, Canada, indicated that only 66% of felt that they needed imaging.…”

Section: Discussionmentioning

confidence: 99%

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Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Ajayi

Schaefer

et al. 2019

Cancer

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BACKGROUND: A possible surveillance model for patients with head and neck cancer (HNC) who received definitive radiotherapy was created using a partially observed Markov decision process. The goal of this model is to guide surveillance imaging policies after definitive radiotherapy. METHODS: The partially observed Markov decision process model was formulated to determine the optimal times to scan patients. Transition probabilities were computed using a data set of 1508 patients with HNC who received definitive radiotherapy between the years 2000 and 2010. Kernel density estimation was used to smooth the sample distributions. The reward function was derived using cost estimates from the literature. Additional model parameters were estimated using either data from the literature or clinical expertise. RESULTS: When considering all forms of relapse, the model showed that the optimal time between scans was longer than the time intervals used in the institutional guidelines. The optimal policy dictates that there should be less time between surveillance scans immediately after treatment compared with years after treatment. Comparable results also held when only locoregional relapses were considered as relapse events in the model. Simulation results for the inclusive relapse cases showed that <15% of patients experienced a relapse over a simulated 36-month surveillance program. CONCLUSIONS: This model suggests that less frequent surveillance scan policies can maintain adequate information on relapse status for patients with HNC treated with radiotherapy. This model could potentially translate into a more cost-effective surveillance program for this group of patients. Cancer 2020;126:749-756.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Ajayi

Schaefer

et al. 2019

Cancer

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“…Moreover, the use of metabolic imaging to differentiate between benign and malignant skull base tumors was beyond the scope of the current work, but it has been described by others. 5,[13][14][15][16][17][18] However, none of them analyzed that issue in skull base malignancies. 24 Third, PET/CT cannot detect lesions smaller than 7 mm in diameter, and this limitation can be even more prominent in patients with a skull base neoplasm or following surgery or radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Positron emission tomography (PET) and, in particular, combined PET-computed tomography (PET/CT) have become popular as useful diagnostic and prognostic tools for pretreatment staging, radiotherapy planning, measuring treatment response for residual or recurrent disease, and monitoring posttreatment follow-up results in various head and neck malignancies. 5,[13][14][15][16][17][18] The diagnostic and prognostic utility of PET/CT is largely undefined in sinonasal and skull base malignancies about which there are only a few studies on relatively small populations. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for head and neck cancers have been updated to include PET/CT as a supplement to the clinical evaluation in the posttreatment surveillance of head and neck squamous cell carcinoma (HNSCC) patients.…”

Section: Introductionmentioning

confidence: 99%

Utility of first positron emission tomography‐computed tomography scan as a prognostic tool following treatment of sinonasal and skull base malignancies

et al. 2018

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Background The prognostic value of the first posttreatment whole body integrated positron emission tomography‐computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies is undetermined. Methods We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000‐2015. The results of the pretreatment and posttreatment PET/CT findings and the clinical course were retrieved. Results Thirty‐eight patients (average age 60.6 years, 20 males) were included. Sensitivity and specificity, positive predictive value, and negative predictive value of the first PET/CT scan for predicting persistent/recurrent disease were 85.7%, 87.5%, 80%, and 91.3%, respectively. Overall 5‐year survival was significantly lower in the first posttreatment PET/CT‐positive group (35%) compared to the PET/CT‐negative group (93%) (P = .0008). Conclusion Posttreatment PET/CT findings are highly prognostic in patients with sinonasal/skull base malignancies. Negative findings on the first posttreatment PET/CT scan predict a significantly better overall survival.

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“…68,[70][71][72] These data seem to hold true for HPV-related oropharyngeal cancers, as studies show NPVs of 91-100% and PPVs of 11-84% in this population. [73][74][75] The PPV could potentially be improved with proper timing and more-consistent interpretation criteria; the rate of false positivity declines with time after treatment cessation, and studies have suggested an optimal time interval of 12 weeks. 67 However, even with optimal timing, absolute SUV max cutoffs have not reliably distinguished residual cancer from inflammation.…”

Section: Dpmentioning

confidence: 98%

Emerging biomarkers in head and neck cancer in the era of genomics

2014

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Head and neck cancer (HNC) broadly includes carcinomas arising from the mucosal epithelia of the head and neck region as well as various cell types of salivary glands and the thyroid. As reflected by the multiple sites and histologies of HNC, the molecular characteristics and clinical outcomes of this disease vary widely. In this Review, we focus on established and emerging biomarkers that are most relevant to nasopharyngeal carcinoma and head and neck squamous-cell carcinoma (HNSCC), which includes primary sites in the oral cavity, oropharynx, hypopharynx and larynx. Applications and limitations of currently established biomarkers are discussed along with examples of successful biomarker development. For emerging biomarkers, preclinical or retrospective data are also described in the context of recently completed comprehensive molecular analyses of HNSCC, which provide a broad genetic landscape and molecular classification beyond histology and clinical characteristics. We will highlight the ongoing effort that will see a shift from prognostic to predictive biomarker development in HNC with the goal of delivering individualized cancer therapy.

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Predictive accuracy of first post‐treatment PET/CT in HPV‐related oropharyngeal squamous cell carcinoma

Abstract: A negative first posttreatment PET/CT result is associated with better prognosis and rare recurrence, especially in patients with HPV-positive status. Less frequent radiologic surveillance is warranted in patients with HPV-positive OPSCC and a negative first posttreatment PET/CT scan.

Cited by 46 publications

References 21 publications

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Utility of first positron emission tomography‐computed tomography scan as a prognostic tool following treatment of sinonasal and skull base malignancies

Emerging biomarkers in head and neck cancer in the era of genomics

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