Up-front PET/CT changes treatment intent in patients with head and neck squamous cell carcinoma

Eur J Nucl Med Mol Imaging. 2018 Apr;45(4):613-621. doi: 10.1007/s00259-017-3873-3. Epub 2017 Nov 10.

Abstract

Purpose: In patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC), we wanted to examine the differences in overall treatment decisions, i.e. curative versus palliative treatment intent, reached by a multidisciplinary team conference (MDTC) based on 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) or chest X-ray + MRI of the head and neck (CXR/MRI).

Patients and methods: This was a prospective blinded cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were invited to participate. All included patients underwent CXR/MRI and PET/CT before diagnostic biopsy. An ordinary MDTC using all available imaging was conducted as per standard practice. After at least 3 months (to eliminate recall bias in the team), the first project MDTC was conducted, based on either CXR/MRI or PET/CT, and the tumor board drew conclusions regarding treatment. After an additional 3 months, a second project MDTC was conducted using the complementary imaging modality.

Results: A total of 307 patients were included. Based on CXR/MRI, 303 patients (99%) were recommended for curative treatment and only four patients (1%) for palliative treatment. Based on PET/CT, the MDTC concluded that 278 (91%) patients were suitable for curative treatment and 29 (9%) patients for palliative treatment. The absolute difference of 8% was statistically significant (95% CI: 4.8%-11.5%, p < 0.001).

Conclusions: A PET/CT-based imaging strategy significantly changed the decisions regarding treatment intent made by a MDTC for patients diagnosed with HNSCC, when compared with the standard imaging strategy of CXR/MRI.

Keywords: HNSCC; MDTC palliation; Patient management; Pet/ct; Treatment plan.

MeSH terms

  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Decision Making*
  • Fluorodeoxyglucose F18
  • Head and Neck Neoplasms / diagnostic imaging*
  • Humans
  • Palliative Care
  • Patient Care Team*
  • Positron Emission Tomography Computed Tomography*
  • Positron-Emission Tomography
  • Prospective Studies
  • Radiopharmaceuticals
  • Tomography, X-Ray Computed

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18