The diagnostic and prognostic utility of positron emission tomography/computed tomography-based follow-up after radiotherapy for head and neck cancer
Kao J et al. - In a study to investigate the clinical value of a follow-up program incorporating serial 18F-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (PET/CT) in detection of recurrent disease in pts with head and neck cancer (HNC), it was shown that although post-therapy follow-up using PET/CT is reportedly associated with a high false-positive rate in the irradiated head and neck, PET/CT appears to be a highly sensitive technique for detection of recurrent disease. Negative PET/CT results within 6 mos of completion of RT offer significant prognostic value. Methods- 240 PET/CT scans were reviewed in 80 pts with HNC who were treated with radiotherapy (RT).
- All pts were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 mos.
Results- Sensitivity, specificity, and positive and negative predictive values of PET/CT-based follow-up for detecting locoregional recurrence were 92%, 82%, 42%, and 98%, respectively.
- Corresponding values for distant metastases or second primary tumors were 93%, 96%, 81%, and 98%, respectively.
- 8 pts (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins.
- 2-yr progression-free survival and 2-yr overall survival rates were significantly different between pts who had a negative and those with a positive PET/CT result within 6 mos of completion of RT (93% vs 30% and 100% vs 32%, respectively).
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