Use of positron emission tomography with fluorodeoxyglucose in patients with extracranial head and neck cancers

Abstract

Background. The purpose of this study was to evaluate the utility of positron emission tomography‐ (PET) 2‐[18F]‐fluoro‐2‐deoxy‐D‐glucose (FDG) imaging in extra‐cranial head and neck cancers. Methods. Sixty patients with biopsy‐proven cancers were studied using PET‐FDG. Thirty‐four patients were studied before therapy (staging), of which 15 patients received primary radiotherapy and serial PET‐FDG imaging (monitoring). Seven patients with advanced disease had laser excision (monitoring), and 19 patients were evaluated for recurrent disease (recurrence). Results. Four patients had unknown primary lesions. PET‐FDG imaging located the primary tumor in two of four patients, and magnetic resonance imaging (MRI) in none of four. In the remaining patients (staging), PET‐FDG imaging detected the primary tumor in 29 of 30 patients, and MRI in 23 of 30. In the staging group, PET‐FDG imaging identified the presence or absence of lymph node involvement in 32 of 34 patients, and MRI in 31 of 34. PET‐FDG imaging was helpful in evaluating tumor response to radiation therapy or laser excision. Ten patients evaluated for recurrent disease had biopsy‐confirmed recurrences, and 7 had no recurrence. PET‐FDG imaging results were positive for primary tumor recurrence in 9 of 10 patients, and MRI results were positive in 6 of 10. MRI results were negative for lymph node disease in one of these patients with recurrent primary tumor where PET‐FDG imaging and biopsy demonstrated nodal involvement. PET‐FDG results were negative for recurrent disease in seven of seven patients, and MRI results were negative for recurrent disease in in four of seven. Conclusion. In this series, the authors found that PET‐FDG is a useful diagnostic modality for evaluating the patient with an unknown primary, monitoring response to therapy, and in detecting recurrent tumors. Cancer 1994; 73:3047–58.

FDG–PET. A possible prognostic factor in head and neck cancer

“…It has been applied to staging and surveillance of patients with head and neck SCC (Rege et al, 1994;Braams et al, 1995), but a more promising observation is that high FDG uptake in head and neck SCC is associated with poor survival (Minn et al, 1997). A similar association has also been demonstrated for other malignancies such as brain, lung and malignant lymphomas (Patronas et al, 1985;Okada et al, 1992;Ahuja et al, 1998), where it appears that the prognostic value of a high SUV may act independently of tumour stage.…”

“…FDG -PET has already been applied to staging and follow-up of patients with head and neck cancer (Rege et al, 1994;Braams et al, 1995), and Minn et al (1997) have shown that high uptake as determined by the standardized uptake value (SUV) was associated with poor survival. However it is not clear whether a high SUV simply reflects the stage of disease or is an independent predictor of survival.…”

Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose

“…They can also indicate uptake and involvement of normal size lymph nodes while showing no involvement in some enlarged reactive lymph nodes. Evaluation of the accuracy of FDG PET in the diagnosis of the primary tumour has been performed to validate its potential in this type of tumour rather than to support its clinical use in this indication [206][207][208][209]. Minn et al were able to image 13/13 cancers using FDG [202].…”

18F-FDG PET as a Routine Posttreatment Surveillance Tool in Oral and Oropharyngeal Squamous Cell Carcinoma: A ProspectiveStudy

“…18 F-FDG PET offers a tool that enables the early detection of HNSCC recurrences. 18 F-FDG PET can distinguish recurrent HNSCC from posttreatment changes and is more effective in detecting recurrent tumors than physical examination, CT, or MRI (8)(9)(10)(11)(12)(13). However, in most of these studies, the objective was to assess the ability of 18 F-FDG PET to visualize a recurrence that was clinically already highly suspected.…”