The diagnostic and prognostic utility of positron emission tomography/computed tomography-based follow-up after radiotherapy for head and neck cancer

Johnny Kao, Linh Vu Ha, Eric M. Genden, Bharat Mocherla, Eunice E. Park, Stuart Packer, Peter M. Som, Lale Kostakoglu

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

BACKGROUND: The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow-up program incorporating serial 18F-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer. METHODS: A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow-up, 21 months). RESULTS: The sensitivity, specificity, and positive and negative predictive values of PET/CT-based followup 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. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2-year progression-free survival and 2-year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively). CONCLUSIONS: 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 the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value.

Original languageEnglish (US)
Pages (from-to)4586-4594
Number of pages9
JournalCancer
Volume115
Issue number19
DOIs
StatePublished - Oct 1 2009
Externally publishedYes

Fingerprint

Head and Neck Neoplasms
Radiotherapy
Recurrence
Neoplasms
Fluorodeoxyglucose F18
Positron-Emission Tomography
Disease-Free Survival
Neck
Survival Rate
Head
Tomography
Positron Emission Tomography Computed Tomography
Neoplasm Metastasis
Sensitivity and Specificity
Survival
Therapeutics

Keywords

  • Computed tomography
  • Head and neck cancer
  • Positron emission tomography
  • Radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

The diagnostic and prognostic utility of positron emission tomography/computed tomography-based follow-up after radiotherapy for head and neck cancer. / Kao, Johnny; Ha, Linh Vu; Genden, Eric M.; Mocherla, Bharat; Park, Eunice E.; Packer, Stuart; Som, Peter M.; Kostakoglu, Lale.

In: Cancer, Vol. 115, No. 19, 01.10.2009, p. 4586-4594.

Research output: Contribution to journalArticle

Kao, Johnny ; Ha, Linh Vu ; Genden, Eric M. ; Mocherla, Bharat ; Park, Eunice E. ; Packer, Stuart ; Som, Peter M. ; Kostakoglu, Lale. / The diagnostic and prognostic utility of positron emission tomography/computed tomography-based follow-up after radiotherapy for head and neck cancer. In: Cancer. 2009 ; Vol. 115, No. 19. pp. 4586-4594.
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abstract = "BACKGROUND: The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow-up program incorporating serial 18F-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer. METHODS: A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow-up, 21 months). RESULTS: The sensitivity, specificity, and positive and negative predictive values of PET/CT-based followup 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. Eight patients (10{\%}) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2-year progression-free survival and 2-year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93{\%} vs 30{\%} [P<.001] and 100{\%} vs 32{\%} [P<.001], respectively). CONCLUSIONS: 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 the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value.",
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T1 - The diagnostic and prognostic utility of positron emission tomography/computed tomography-based follow-up after radiotherapy for head and neck cancer

AU - Kao, Johnny

AU - Ha, Linh Vu

AU - Genden, Eric M.

AU - Mocherla, Bharat

AU - Park, Eunice E.

AU - Packer, Stuart

AU - Som, Peter M.

AU - Kostakoglu, Lale

PY - 2009/10/1

Y1 - 2009/10/1

N2 - BACKGROUND: The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow-up program incorporating serial 18F-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer. METHODS: A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow-up, 21 months). RESULTS: The sensitivity, specificity, and positive and negative predictive values of PET/CT-based followup 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. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2-year progression-free survival and 2-year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively). CONCLUSIONS: 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 the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value.

AB - BACKGROUND: The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow-up program incorporating serial 18F-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer. METHODS: A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow-up, 21 months). RESULTS: The sensitivity, specificity, and positive and negative predictive values of PET/CT-based followup 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. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2-year progression-free survival and 2-year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively). CONCLUSIONS: 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 the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value.

KW - Computed tomography

KW - Head and neck cancer

KW - Positron emission tomography

KW - Radiotherapy

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DO - 10.1002/cncr.24493

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