Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
Cancer. 2013 Apr 1;119(7):1349-56. doi: 10.1002/cncr.27892. Epub 2012 Dec 7.
In head and neck cancer (HNC), 3-month post-treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of post-treatment PET/CT surveillance on outcomes is assessed at 12 and 24 months.
A 10-year retrospective analysis of HNC patients was carried out with long-term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3-month scans, 175 had 3- and 12-month scans, and 77 had 3-, 12-, and 24-month scans.
PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT-detected and clinically detected recurrences, with similar 3-year disease-free survival (41% vs 46%, P = .91) and 3-year overall survival (60% vs 54%, P = .70) rates. Compared with 3-month PET/CT, 12-month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive.
HNC patients with negative 3-month imaging appear to derive limited benefit from subsequent PET/CT surveillance. No survival differences were observed between PET/CT-detected and clinically detected recurrences, although larger prospective studies are needed for further investigation.
在头颈部癌症（HNC）中，治疗后 3 个月的正电子发射断层扫描（PET）/计算机断层扫描（CT）可可靠地识别持续性/复发性疾病。然而，进一步的 PET/CT 监测的获益并不明确。治疗后 PET/CT 监测对结果的影响在 12 个月和 24 个月时进行评估。
对 HNC 患者进行了一项为期 10 年的回顾性分析，对其进行了长期的连续影像学检查。3 个月时的影像学检查包括 PET/CT 或磁共振成像，所有后续的影像学检查均包括 PET/CT。仅在之前的间隔扫描为阴性时，才对 12 个月和 24 个月的 PET/CT 扫描进行评估。在确定的 1114 名患者中，有 284 名患者进行了 3 个月的扫描，有 175 名患者进行了 3 个月和 12 个月的扫描，有 77 名患者进行了 3 个月、12 个月和 24 个月的扫描。
在临床隐匿性患者中，12 个月时 PET/CT 的检出率为 9%（15/175），24 个月时为 4%（3/77）。在 PET/CT 检出和临床检出的复发之间，没有观察到结局的差异，3 年无疾病生存率（41% vs. 46%，P =.91）和 3 年总生存率（60% vs. 54%，P =.70）相似。与 3 个月的 PET/CT 相比，12 个月的 PET/CT 显示出更少的不确定读片（26% vs. 10%，P<.001）。在被认为不确定的扫描中，有 6%（5/89）最终被发现为阳性。
对于 3 个月影像学检查阴性的 HNC 患者，随后进行 PET/CT 监测获益有限。虽然需要更大的前瞻性研究进一步研究，但在 PET/CT 检出和临床检出的复发之间未观察到生存差异。
