Abstract
F-18 FDG PET/CT has been widely used to diagnose primary tumors and lymph node metastases and to evaluate the response of head and neck squamous cell carcinoma (HNSCC) to therapy. The advantage of using PET/CT is that this combination allows metabolic information to be precisely overlapped with anatomical information, thereby improving the identification of sites with an abnormal accumulation of F-18 FDG. The role of FDG PET/CT in the therapeutic evaluation (such as in treatment planning, the therapeutic response, and the surveillance and examination of HNSCC patients) is discussed in this manuscript. When evaluating the post-treatment outcome via FDG PET/CT, it is important to exclude the post-treatment inflammation-related increase in glucose metabolism in lymph nodes, salivary gland, muscles, and soft tissues. The influence of inflammation can be eliminated if PET/CT is performed after 12 weeks, by which time post-treatment inflammation subsides. Further, FDG PET/CT affords a high negative predictive value. Based on the results of an FDG PET/CT test, some invasive tests that are performed to detect recurrence can be omitted.
Similar content being viewed by others
References
Strauss LG, Conti PS. The applications of PET in clinical oncology. J Nucl Med. 1991;32:623–48. discussion 49–50.
Rege SD, Chaiken L, Hoh CK, Choi Y, Lufkin R, Anzai Y, et al. Change induced by radiation therapy in FDG uptake in normal and malignant structures of the head and neck: quantitation with PET. Radiology. 1993;189:807–12.
Greven KM, Williams DW 3rd, Keyes JW Jr, McGuirt WF, Watson NE Jr, Randall ME, et al. Positron emission tomography of patients with head and neck carcinoma before and after high dose irradiation. Cancer. 1994;74:1355–9.
Keyes JW Jr, Watson NE Jr, Williams DW 3rd, Greven KM, McGuirt WF. FDG PET in head and neck cancer. AJR Am J Roentgenol. 1997;169:1663–9.
Rick O, Beyer J, Kingreen D, Schwella N, Krusch A, Schleicher J, et al. High-dose chemotherapy in germ cell tumours: a large single centre experience. Eur J Cancer. 1998;34:1883–8.
Ruhlmann J, Oehr P, Biersack HJ. PET in oncology: basics and clinical application. Berlin: Springer; 1999.
Ishikita T, Oriuchi N, Higuchi T, Miyashita G, Arisaka Y, Paudyal B, et al. Additional value of integrated PET/CT over PET alone in the initial staging and follow up of head and neck malignancy. Ann Nucl Med. 2010;24:77–82.
Agarwal V, Branstetter BFt, Johnson JT. Indications for PET/CT in the head and neck. Otolaryngol Clin North Am. 2008;41:23–49, v.
Ha PK, Hdeib A, Goldenberg D, Jacene H, Patel P, Koch W, et al. The role of positron emission tomography and computed tomography fusion in the management of early-stage and advanced-stage primary head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 2006;132:12–6.
Deantonio L, Beldi D, Gambaro G, Loi G, Brambilla M, Inglese E, et al. FDG-PET/CT imaging for staging and radiotherapy treatment planning of head and neck carcinoma. Radiat Oncol. 2008;3:29.
Wang D, Schultz CJ, Jursinic PA, Bialkowski M, Zhu XR, Brown WD, et al. Initial experience of FDG-PET/CT guided IMRT of head-and-neck carcinoma. Int J Radiat Oncol Biol Phys. 2006;65:143–51.
Porceddu SV, Burmeister BH, Hicks RJ. Role of functional imaging in head and neck squamous cell carcinoma: fluorodeoxyglucose positron emission tomography and beyond. Hematol Oncol Clin North Am. 2008;22:1221–38, ix–x.
Subramaniam RM, Truong M, Peller P, Sakai O, Mercier G. Fluorodeoxyglucose-positron-emission tomography imaging of head and neck squamous cell cancer. AJNR Am J Neuroradiol. 2009;31:598–604.
Troost EG, Schinagl DA, Bussink J, Boerman OC, van der Kogel AJ, Oyen WJ, et al. Innovations in radiotherapy planning of head and neck cancers: role of PET. J Nucl Med. 2009;51:66–76.
Ciernik IF, Dizendorf E, Baumert BG, Reiner B, Burger C, Davis JB, et al. Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): a feasibility study. Int J Radiat Oncol Biol Phys. 2003;57:853–63.
Paulino AC, Koshy M, Howell R, Schuster D, Davis LW. Comparison of CT- and FDG-PET-defined gross tumor volume in intensity-modulated radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:1385–92.
Kao CH, Hsieh TC, Yu CY, Yen KY, Yang SN, Wang YC, et al. 18F-FDG PET/CT-based gross tumor volume definition for radiotherapy in head and neck cancer: a correlation study between suitable uptake value threshold and tumor parameters. Radiat Oncol. 2010;5:76.
Yao M, Graham MM, Hoffman HT, Smith RB, Funk GF, Graham SM, et al. The role of post-radiation therapy FDG PET in prediction of necessity for post-radiation therapy neck dissection in locally advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2004;59:1001–10.
Andrade RS, Heron DE, Degirmenci B, Filho PA, Branstetter BF, Seethala RR, et al. Posttreatment assessment of response using FDG-PET/CT for patients treated with definitive radiation therapy for head and neck cancers. Int J Radiat Oncol Biol Phys. 2006;65:1315–22.
Isles MG, McConkey C, Mehanna HM. A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol. 2008;33:210–22.
Hermans R, Pameijer FA, Mancuso AA, Parsons JT, Mendenhall WM. Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone? Radiology. 2000;214:683–7.
Kitagawa Y, Nishizawa S, Sano K, Ogasawara T, Nakamura M, Sadato N, et al. Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67 Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med. 2003;44:198–206.
Kubota K, Yokoyama J, Yamaguchi K, Ono S, Qureshy A, Itoh M, et al. FDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT. Eur J Nucl Med Mol Imaging. 2004;31:590–5.
Zimmer LA, Branstetter BF, Nayak JV, Johnson JT. Current use of 18F-fluorodeoxyglucose positron emission tomography and combined positron emission tomography and computed tomography in squamous cell carcinoma of the head and neck. Laryngoscope. 2005;115:2029–34.
Lapela M, Eigtved A, Jyrkkio S, Grenman R, Kurki T, Lindholm P, et al. Experience in qualitative and quantitative FDG PET in follow-up of patients with suspected recurrence from head and neck cancer. Eur J Cancer. 2000;36:858–67.
Branstetter BFt, Blodgett TM, Zimmer LA, Snyderman CH, Johnson JT, Raman S, et al. Head and neck malignancy: is PET/CT more accurate than PET or CT alone? Radiology. 2005;235:580–6.
Blodgett TM, Fukui MB, Snyderman CH, Branstetter BFt, McCook BM, Townsend DW, et al. Combined PET-CT in the head and neck: part 1. Physiologic, altered physiologic, and artifactual FDG uptake. Radiographics. 2005;25:897–912.
Zimmer LA, Snyderman C, Fukui MB, Blodgett T, McCook B, Townsend DW, et al. The use of combined PET/CT for localizing recurrent head and neck cancer: the Pittsburgh experience. Ear Nose Throat J. 2005;84:104, 06, 08–10.
Chen AY, Vilaseca I, Hudgins PA, Schuster D, Halkar R. PET-CT vs contrast-enhanced CT: what is the role for each after chemoradiation for advanced oropharyngeal cancer? Head Neck. 2006;28:487–95.
Schoder H, Fury M, Lee N, Kraus D. PET monitoring of therapy response in head and neck squamous cell carcinoma. J Nucl Med. 2009;50(Suppl 1):74S–88S.
Quon A, Fischbein NJ, McDougall IR, Le QT, Loo BW Jr, Pinto H, et al. Clinical role of 18F-FDG PET/CT in the management of squamous cell carcinoma of the head and neck and thyroid carcinoma. J Nucl Med. 2007;48(Suppl 1):58S–67S.
Ryan WR, Fee WE Jr, Le QT, Pinto HA. Positron-emission tomography for surveillance of head and neck cancer. Laryngoscope. 2005;115:645–50.
Lonneux M, Lawson G, Ide C, Bausart R, Remacle M, Pauwels S. Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient. Laryngoscope. 2000;110:1493–7.
Ong SC, Schoder H, Lee NY, Patel SG, Carlson D, Fury M, et al. Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced head and neck cancer. J Nucl Med. 2008;49:532–40.
Brkovich VS, Miller FR, Karnad AB, Hussey DH, McGuff HS, Otto RA. The role of positron emission tomography scans in the management of the N-positive neck in head and neck squamous cell carcinoma after chemoradiotherapy. Laryngoscope. 2006;116:855–8.
Shishido F, Senda M, Itoh K, Inoue T, kumita S, Sasaki M, et al. Clinical guide line for FDG PET, PET/CT (written in Japanese). Kakuigaku. 2010;2010(47):153–62.
Lavertu P, Adelstein DJ, Saxton JP, Secic M, Wanamaker JR, Eliachar I, et al. Management of the neck in a randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer. Head Neck. 1997;19:559–66.
Nayak JV, Walvekar RR, Andrade RS, Daamen N, Lai SY, Argiris A, et al. Deferring planned neck dissection following chemoradiation for stage IV head and neck cancer: the utility of PET-CT. Laryngoscope. 2007;117:2129–34.
Gupta T, Jain S, Agarwal JP, Rangarajan V, Purandare N, Ghosh-Laskar S, et al. 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;97:194–9.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Kawabe, J., Higashiyama, S., Yoshida, A. et al. The role of FDG PET-CT in the therapeutic evaluation for HNSCC patients. Jpn J Radiol 30, 463–470 (2012). https://doi.org/10.1007/s11604-012-0076-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-012-0076-5