Positron emission tomography/computed tomography after primary transoral robotic surgery for oropharyngeal squamous cell carcinoma

Laryngoscope. 2017 Sep;127(9):2050-2056. doi: 10.1002/lary.26515. Epub 2017 Mar 8.

Abstract

Objectives/hypothesis: To assess the first post-treatment positron emission tomography/computed tomography (PET/CT) in prediction of disease-free survival after primary transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) with or without adjuvant chemoradiation.

Study design: Retrospective review.

Methods: Ninety-five patients with OPSCC treated with primary TORS from 2010 to 2014 at a single tertiary academic center were evaluated with PET/CT. Imaging was performed between 2 and 7 months after completing all treatment. Radiology findings were categorized as 1) negative, noting either complete resolution of foci without evidence of disease or anatomical changes likely attributed to treatment; 2) equivocal, noting equal likelihood of malignancy versus treatment-related changes; or 3) positive, noting either findings concerning for malignancy or new hyperactivity not attributed to treatment-related changes. The median follow-up time was 31 months (range, 23-63 months). Recurrence was defined as biopsy-proven invasive malignancy or clinical suspicion sufficient to initiate treatment occurring within 3 years of the completion of all treatment.

Results: Of 95 total patients with at least 2 years of follow-up records, 26 had positive post-treatment PET/CT results, with five experiencing actual recurrences. Of 69 patients with negative post-treatment PET/CT results, none experienced recurrences. These results indicate a sensitivity of 100%, specificity of 77%, positive predictive value of 19%, and negative predictive value of 100%.

Conclusions: A majority of TORS patients (73%) will have a negative first post-treatment PET/CT. A single negative post-treatment PET/CT is strongly correlated with 2-year disease-free survival in patients treated with primary TORS and may warrant decreased surveillance imaging.

Level of evidence: 4 Laryngoscope, 127:2050-2056, 2017.

Keywords: Oropharynx; PET imaging; TORS; radiology; robotic surgery.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / surgery
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mouth / surgery
  • Natural Orifice Endoscopic Surgery / methods*
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Oropharyngeal Neoplasms / diagnostic imaging*
  • Oropharyngeal Neoplasms / surgery
  • Positron Emission Tomography Computed Tomography / methods
  • Positron Emission Tomography Computed Tomography / statistics & numerical data*
  • Postoperative Period
  • Predictive Value of Tests
  • Retrospective Studies
  • Robotic Surgical Procedures / methods*
  • Sensitivity and Specificity
  • Treatment Outcome