Positron emission tomography in the early follow-up of advanced head and neck cancer

Arch Otolaryngol Head Neck Surg. 2004 Jan;130(1):105-9; discussion 120-1. doi: 10.1001/archotol.130.1.105.


Objective: To assess the clinical effect of an early follow-up positron emission tomography (PET) examination at the time of the first routine clinical control in patients with advanced-stage head and neck squamous cell carcinoma (HNSCC).

Design: Prospective, nonrandomized, case-control study.

Setting: Single referral center.

Patients and intervention: A total of 26 patients (mean age, 56 years) with histologically confirmed stage III-IV HNSCC underwent PET before and approximately 6 weeks after the end of a combined treatment with radiation and chemotherapy with curative intent. The PET findings were confirmed by histologic analysis and a 6-month clinical follow-up.

Main outcome measures: The presence of distant metastases, secondary synchronous cancers, and residual locoregional tissue was confirmed, and the effect on further clinical management was assessed.

Results: Using PET, we correctly identified residual tumor tissue, distant metastases, or a second primary tumor in 10 patients, 5 of whom had no clinical evidence of such findings. Results were true negative in 14 cases; false positive in 1; and false negative in 1. Sensitivity and specificity for follow-up PET scans were 90.9% and 93.3%, respectively. All patients with positive findings were evaluated for further treatment such as salvage surgery.

Conclusions: Whole-body PET scanning approximately 6 weeks after completion of a combined treatment regimen with radiation and chemotherapy can reliably identify locoregional residual cancer and distant metastases or secondary tumors in patients with advanced-stage HNSCC and has a direct influence on management decisions.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Metastasis / diagnostic imaging
  • Prospective Studies
  • Sensitivity and Specificity
  • Tomography, Emission-Computed*
  • Whole-Body Counting