Huang Yi-Tung Tom, Ravi Kumar Aravind S
Queensland PET Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Nucl Med Commun. 2012 May;33(5):503-8. doi: 10.1097/MNM.0b013e32835095d8.
Fluorine-18 fluorodeoxyglucose PET/computed tomography (CT) is now routinely used for staging and monitoring treatment response in head and neck squamous cell carcinoma (HNSCC). Although most patients with HSNCC have locoregional disease, distant metastases are relatively uncommon and occur predominantly in the lungs.
To explore the potential of a limited scan range from the skull vertex to lung bases, viz. an 'above diaphragm' scan, as an adequate examination for assessment of disease following chemoradiotherapy.
A retrospective review of 240 patients with HNSCC both staged and monitored after therapy with (18)F-fluorodeoxyglucose PET/CT was conducted. Patients with previous HNSCC, unknown primary and known distant metastatic disease were excluded. Patients with positive PET/CT findings below the neck on the posttherapy study were confirmed on either follow-up clinical or radiological findings.
A total of 196 (81.7%) patients had nodal disease at PET/CT staging. Unrelated findings were present in 50 (20.8%) patients, including five colonic neoplasms and two second malignancies. After an average of 6.4 months after staging, 13 patients (5.4%) demonstrated progression to distant metastases on the posttherapy PET/CT. All patients demonstrated intrapulmonary metastases. Two patients had additional liver metastases, which would not have impacted on the overall management. No patient demonstrated isolated disease below the diaphragm.
A limited 'above-diaphragm' scan for early assessment following chemoradiotherapy may be safely considered. The benefits of this tailored approach flow onto both the health system and the patients as it can improve resource allocation by increasing scanner availability and patient throughput and reduces cumulative patient radiation exposure.
氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）目前常用于头颈部鳞状细胞癌（HNSCC）的分期及监测治疗反应。尽管大多数HNSCC患者为局部区域性病变，但远处转移相对少见，主要发生在肺部。
探讨从颅顶至肺底部的有限扫描范围，即“膈上”扫描，作为放化疗后疾病评估的充分检查方法的潜力。
对240例接受（18）F-氟脱氧葡萄糖PET/CT分期及治疗后监测的HNSCC患者进行回顾性分析。排除既往有HNSCC、原发灶不明及已知远处转移疾病的患者。治疗后PET/CT检查发现颈部以下有阳性结果的患者，通过后续临床或影像学检查结果进行确认。
共有196例（81.7%）患者在PET/CT分期时有淋巴结病变。50例（20.8%）患者存在无关发现，包括5例结肠肿瘤和2例第二原发恶性肿瘤。分期后平均6.4个月，13例（5.4%）患者在治疗后PET/CT上显示进展为远处转移。所有患者均表现为肺内转移。2例患者有额外的肝转移，这对整体治疗并无影响。没有患者表现为孤立的膈下病变。
放化疗后早期评估可安全考虑采用有限的“膈上”扫描。这种定制方法的益处体现在卫生系统和患者两方面，因为它可以通过提高扫描仪可用性和患者通量来改善资源分配，并减少患者的累积辐射暴露。
