Keski-Säntti Harri, Mustonen Timo, Schildt Jukka, Saarilahti Kauko, Mäkitie Antti A
Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
Clin Med Insights Ear Nose Throat. 2014 Aug 19;7:25-9. doi: 10.4137/CMENT.S16399. eCollection 2014.
In many centers, (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used to monitor treatment response after definitive (chemo)radiotherapy [(C)RT] for head and neck squamous cell carcinoma (HNSCC), but its usefulness remains somewhat controversial. We aimed at assessing the accuracy of FDG-PET/CT in detecting residual disease after (C)RT.
All HNSCC patients with FDG-PET/CT performed to assess treatment response 10-18 weeks after definitive (C)RT at our institution during 2008-2010 were included. The patient charts were reviewed for FDG-PET/CT findings, histopathologic findings, and follow-up data. The median follow-up time for FDG-PET/CT negative patients was 26 months.
Eighty-eight eligible patients were identified. The stage distribution was as follows: I, n = 1; II, n = 15; III, n = 17; IV, n = 55. The negative predictive value, positive predictive value, specificity, sensitivity, and accuracy of FDG-PET/CT in detecting residual disease were 87%, 81%, 94%, 65%, and 85%, respectively. The corresponding specific figures for the primary tumor site were 91%, 71%, 94%, 59%, and 86% and for the neck 93%, 100%, 100%, 75%, and 94%, respectively.
In patients who have received definitive (C)RT for HNSCC, post-treatment FDG-PET/CT has good potential to guide clinical decision-making. Patients with negative scan can safely be followed up clinically only, while positive scan necessitates tissue biopsies or a neck dissection to rule out residual disease.
在许多中心，（18）F-氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）用于监测头颈部鳞状细胞癌（HNSCC）根治性（化疗）放疗[（C）RT]后的治疗反应，但其效用仍存在一定争议。我们旨在评估FDG-PET/CT在检测（C）RT后残留疾病方面的准确性。
纳入2008年至2010年期间在本机构接受根治性（C）RT后10 - 18周进行FDG-PET/CT以评估治疗反应的所有HNSCC患者。查阅患者病历以获取FDG-PET/CT检查结果、组织病理学检查结果和随访数据。FDG-PET/CT检查结果为阴性的患者中位随访时间为26个月。
共确定88例符合条件的患者。分期分布如下：I期，n = 1；II期，n = 15；III期，n = 17；IV期，n = 55。FDG-PET/CT检测残留疾病的阴性预测值、阳性预测值、特异性、敏感性和准确性分别为87%、81%、94%、65%和85%。原发肿瘤部位的相应具体数值分别为91%、71%、94%、59%和86%，颈部的相应具体数值分别为93%、100%、100%、75%和94%。
对于接受HNSCC根治性（C）RT的患者，治疗后FDG-PET/CT在指导临床决策方面具有良好潜力。扫描结果为阴性的患者可仅进行临床随访，而扫描结果为阳性的患者则需要进行组织活检或颈部清扫以排除残留疾病。
