Treatment response in the neck: p16+ versus p16− oropharyngeal cancer

Mak, Daisy; Hicks, Rodney J.; Rischin, Danny; Solomon, Benjamin; Peters, Lester J.; Bressel, Mathias; Young, Richard J.; Corry, June

doi:10.1111/1754-9485.12024

Cited by 20 publications

(34 citation statements)

References 17 publications

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“…25,26 In another study, PET-CT was significantly more accurate than CT in identifying a complete nodal response, especially in patients with HPV-positive disease (93% vs. 50%). 21 A prospective singleinstitution study also showed that PET-CT surveillance was more cost-effective than CT surveillance, regardless of HPV status. 24 In the same study, CT followed by PET-CT in patients who did not have a response was shown to be only marginally more cost-effective than PET-CT alone, and with small changes in baseline assumptions and costs, CT followed by PET-CT ceased to be costeffective as compared with PET-CT alone.…”

Section: Discussionmentioning

confidence: 97%

“…Other researchers have reported that nodes with no FDG uptake have very high rates of regional control (93%), especially in HPV-positive disease. 21 We recommend that patients with an equivocal FDG uptake should continue to undergo neck dissection, especially if they have HPV-negative disease. However, patients with HPV-positive cancers who have enlarged nodes but no FDG uptake after chemoradiotherapy may be considered for close follow-up 11 with serial CT or PET-CT; this strategy may spare even more patients from undergoing a neck dissection.…”

Section: Discussionmentioning

confidence: 99%

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PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer

et al. 2016

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BACKGROUNDThe role of image-guided surveillance as compared with planned neck dissection in the treatment of patients with squamous-cell carcinoma of the head and neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate. METHODSIn this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography-computed tomography (PET-CT)-guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with neck dissection performed only if PET-CT showed an incomplete or equivocal response) to planned neck dissection in patients with stage N2 or N3 disease. The primary end point was overall survival. RESULTSFrom 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the patients had oropharyngeal cancer, and 75% had tumor specimens that stained positive for the p16 protein, an indicator that human papillomavirus had a role in the causation of the cancer. The median follow-up was 36 months. PET-CT-guided surveillance resulted in fewer neck dissections than did planned dissection surgery (54 vs. 221); rates of surgical complications were similar in the two groups (42% and 38%, respectively). The 2-year overall survival rate was 84.9% (95% confidence interval [CI], 80.7 to 89.1) in the surveillance group and 81.5% (95% CI, 76.9 to 86.3) in the planned-surgery group. The hazard ratio for death slightly favored PET-CT-guided surveillance and indicated noninferiority (upper boundary of the 95% CI for the hazard ratio, <1.50; P = 0.004). There was no significant difference between the groups with respect to p16 expression. Quality of life was similar in the two groups. PET-CT-guided surveillance, as compared with neck dissection, resulted in savings of £1,492 (approximately $2,190 in U.S. dollars) per person over the duration of the trial. CONCLUSIONSSurvival was similar among patients who underwent PET-CT-guided surveillance and those who underwent planned neck dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer

et al. 2016

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“…Post-treatment FDG PET-CT has an NPV up to 99% for nodal disease (when performed at 4 months), 17 benefit over conventional assessment (anatomical imaging and clinical examination) 18 and a high probability of long-term regional control (2.3% regional failure rate at 36 months). 19 A recent randomized controlled trial, the UK PET-NECK study, demonstrated that PET-CT surveillance had equivalent survival outcome at lower overall cost, when compared with routine neck dissection for N2/3 nodal disease post-CRT for advanced nodal disease.…”

Section: Current Uses Of Fdg Positron Emission Tomography-ct In Treatmentioning

confidence: 99%

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

Cliffe

Patel

Prestwich

et al. 2017

The British Journal of Radiology

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Radiation therapy is a common component of curative cancer treatment. However, there is a significant incidence of treatment failure. In these cases, salvage surgical options are sometimes appropriate. Accurate assessment of response and early recognition of treatment success or failure is therefore critical to guide treatment decisions and impacts on survival and the morbidity of treatment. Traditionally, treatment response has depended upon the anatomical measurement of disease. However, this may not correlate well with the presence of disease, especially after radiotherapy. Combined positron emission tomography (PET) and CT imaging employs radioactive tracers to identify molecular characteristics of tissues. PET imaging exploits the fact that malignancies have characteristic molecular profiles which differ compared with surrounding tissues. The complementary anatomical and functional information facilitates accurate non-invasive assessment of surrogate biomarkers of disease activity.This article reviews the rationale for positron emission tomography (PET)-CT response assessment in radiation oncology, describing current uses of 2-[18 F]-fluoro-2-deoxy-D-glucose (FDG) PET-CT in treatment response following radiotherapy in head and neck, oesophageal, rectal and brain tumours. Emerging applications of FDG PET-CT in cervical and lung carcinomas and hepato-pancreatico-biliary tumours, particularly pancreatic carcinoma and liver metastases (post-selective internal radiotherapy treatment), are reviewed. Finally, the limitations of FDG PET-CT are considered, highlighting areas for future development.

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“…Recent reports suggest human papillomavirus (HPV)þ nodal disease may take longer to reduce in size [11 & ], and therefore may present with equivocal FDG PET-CT scans (in particular with enlarged nodes on the CT scan component, but without FDG avidity) at the 12 week post-CRT assessment. Other recent reports suggest that patients who show no FDG uptake had very low recurrence rates, especially if they had HPVþ disease (93%) [9,12]. Therefore, patients with HPVþ disease who show enlarged nodes but no FDG uptake after CRT may be considered for close surveillance with serial frequent scans.…”

Section: Human Papillomavirus Disease and Equivocal Positron Emissionmentioning

confidence: 99%

“…Indeed, other studies that compared FDG PET-CT to CT have reported much higher efficacy of FDG PET-CT compared with CT in HPVþ patients. Mak et al [12] reported that FDG PET/PET-CT scanning at a mean time of 12 weeks (range 8-16 weeks) following treatment was significantly more accurate at predicting complete response (90%) compared with contrasted CT assessment (46%), and especially for HPVþ patients (93% vs. 50%). In one of the largest studies to date, which specifically considered FDG PET-CT response in HPVþ oropharyngeal cancer, FDG PET-CT at 12 weeks after CRT demonstrated high negative predictive value for loco-regional failure though with disappointing positive predictive value and sensitivity [15].…”

Section: Key Pointsmentioning

confidence: 99%