Diagnostic performance of response assessment FDG-PET/CT in patients with head and neck squamous cell carcinoma treated with high-precision definitive (chemo)radiation

Radiother Oncol. 2010 Nov;97(2):194-9. doi: 10.1016/j.radonc.2010.04.028. Epub 2010 Jun 2.

Abstract

Purpose: To prospectively assess diagnostic performance of response assessment fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with HNSCC treated with high-precision definitive (chemo)radiation.

Methods: Fifty-seven patients treated on a prospective clinical trial having post-treatment response assessment FDG-PET/CT scans were included. Clinico-pathologic findings and follow-up information was considered as reference standard.

Results: First response assessment FDG-PET/CT was done at a median of 9 weeks (inter-quartile range 8-10 weeks) from completion of treatment. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of first response assessment FDG-PET/CT for identifying residual disease at primary site was 50%, 91.8%, 50%, 91.8%, and 86%. The corresponding figures for the neck were 62.5%, 98%, 83.3%, 94.1%, and 93%. With a median follow-up of 26 months (range 7-45 months), the 3-year loco-regional control (83.9% vs 58.3%, p=0.001) and overall survival (68.8% vs 58.3%, p=0.063) was significantly better in patients with negative response assessment scans.

Conclusion: The overall diagnostic accuracy of response assessment FDG-PET/CT is good, but its sensitivity and PPV is somewhat low, particularly for primary site. A negative response assessment FDG-PET/CT scan is highly suggestive of absence of viable disease that could be used to guide decision-making.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols*
  • Carcinoma, Squamous Cell* / diagnosis
  • Carcinoma, Squamous Cell* / radiotherapy
  • Carcinoma, Squamous Cell* / therapy
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Head and Neck Neoplasms* / diagnosis
  • Head and Neck Neoplasms* / radiotherapy
  • Head and Neck Neoplasms* / therapy
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Positron-Emission Tomography*
  • Tomography, X-Ray Computed

Substances

  • Fluorodeoxyglucose F18