Detection of locoregional recurrent head and neck cancer after (chemo)radiotherapy using modern imaging

Oral Oncol. 2009 Apr-May;45(4-5):386-93. doi: 10.1016/j.oraloncology.2008.10.015. Epub 2008 Dec 17.

Abstract

After radiotherapy with or without chemotherapy differentiation between residual and recurrent head and neck cancer and (chemo)radiation sequelae is often difficult. Currently, most physicians aggressively pursue potential recurrences, leading to a high rate of futile invasive diagnostic, e.g. examinations under general anaesthesia with taking of biopsies, and surgical procedures, e.g. planned neck dissections, and a waste of health care resources. Therefore, diagnostic techniques which reliably select patients who should undergo these procedures are warranted. Conventional imaging techniques are not reliable enough for this purpose. Potential imaging techniques to detect residual and recurrent locoregional disease after chemoradiation are (serial) CT or MRI and FDG-PET, eventually in combination with specific response criteria or scoring systems. Diffusion MRI and PET/CT may further improve these techniques. FDG-PET may help to select patients clinically suspected of recurrent laryngeal carcinoma after radiotherapy for direct laryngoscopy under general anaesthesia. It is not yet clear whether FDG-PET can reliable avoid futile routine evaluation by examination under general anaesthesia in oral and oropharyngeal cancer and planned neck dissection when a residual mass persists in the neck after (chemo)radiation. The most reliable scoring criteria and the optimal time interval between completion of radiation and FDG-PET still has to be assessed.

Publication types

  • Review

MeSH terms

  • Diffusion Magnetic Resonance Imaging / methods
  • Fluorodeoxyglucose F18
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / drug therapy
  • Head and Neck Neoplasms / radiotherapy
  • Humans
  • Laryngeal Neoplasms / diagnosis
  • Laryngeal Neoplasms / drug therapy
  • Laryngeal Neoplasms / radiotherapy
  • Magnetic Resonance Imaging / methods
  • Mouth Neoplasms / diagnosis
  • Mouth Neoplasms / drug therapy
  • Mouth Neoplasms / radiotherapy
  • Neoplasm Recurrence, Local / diagnosis*
  • Oropharyngeal Neoplasms / diagnosis
  • Oropharyngeal Neoplasms / drug therapy
  • Oropharyngeal Neoplasms / radiotherapy
  • Positron-Emission Tomography / methods
  • Prognosis
  • Radiopharmaceuticals
  • Recurrence
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18