Department of Otolaryngology, Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
Oral Oncol. 2009 Apr-May;45(4-5):386-93. doi: 10.1016/j.oraloncology.2008.10.015. Epub 2008 Dec 17.
After radiotherapy with or without chemotherapy differentiation between residual and recurrent head and neck cancer and (chemo)radiation sequelae is often difficult. Currently, most physicians aggressively pursue potential recurrences, leading to a high rate of futile invasive diagnostic, e.g. examinations under general anaesthesia with taking of biopsies, and surgical procedures, e.g. planned neck dissections, and a waste of health care resources. Therefore, diagnostic techniques which reliably select patients who should undergo these procedures are warranted. Conventional imaging techniques are not reliable enough for this purpose. Potential imaging techniques to detect residual and recurrent locoregional disease after chemoradiation are (serial) CT or MRI and FDG-PET, eventually in combination with specific response criteria or scoring systems. Diffusion MRI and PET/CT may further improve these techniques. FDG-PET may help to select patients clinically suspected of recurrent laryngeal carcinoma after radiotherapy for direct laryngoscopy under general anaesthesia. It is not yet clear whether FDG-PET can reliable avoid futile routine evaluation by examination under general anaesthesia in oral and oropharyngeal cancer and planned neck dissection when a residual mass persists in the neck after (chemo)radiation. The most reliable scoring criteria and the optimal time interval between completion of radiation and FDG-PET still has to be assessed.
在接受放化疗或不放化疗后，头颈部癌症的残留肿瘤和复发性肿瘤与（放化疗）后遗症之间的区分往往较为困难。目前，大多数医生积极追求潜在的复发，导致大量不必要的侵入性诊断，例如全身麻醉下进行活检，以及手术程序，例如计划的颈部解剖，浪费了医疗保健资源。因此，有必要采用可靠的诊断技术来选择需要进行这些程序的患者。传统的影像学技术在此方面并不可靠。用于检测放化疗后局部区域残留和复发性疾病的潜在影像学技术包括（连续）CT 或 MRI 和 FDG-PET，最终与特定的反应标准或评分系统相结合。扩散 MRI 和 PET/CT 可能会进一步改进这些技术。FDG-PET 可能有助于选择在接受放射治疗后临床怀疑患有喉癌的患者，以便在全身麻醉下进行直接喉镜检查。目前尚不清楚 FDG-PET 是否可以在（放化疗）后颈部残留肿块时，可靠地避免口腔和口咽癌中常规全身麻醉下评估以及计划的颈部解剖中不必要的常规评估。仍需评估最可靠的评分标准和 FDG-PET 之间的最佳时间间隔。
