van Egmond Sylvia L, Piscaer Vera, Janssen Luuk M, Stegeman Inge, Hobbelink Monique G, Grolman Wilko, Terhaard Chris H
a Department of Otorhinolaryngology and Head & Neck Surgery , University Medical Center Utrecht , Utrecht , The Netherlands.
b Department Head and Neck Surgical Oncology , UMC Cancer Center, University Medical Center Utrecht , Utrecht , The Netherlands.
Acta Oncol. 2016 Sep-Oct;55(9-10):1099-1106. doi: 10.1080/0284186X.2016.1182643. Epub 2016 May 24.
The role of 2-[F]-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in routine diagnostic staging remains controversial. In case of discordance between FDG-PET and CT, a compromise has to be made between the risk of false positive FDG-PET and the risk of delaying appropriate salvage intervention. Second, with intensity modulated radiation therapy (IMRT), smaller radiation fields allow tissue sparing, but could also lead to more marginal failures.
We retrospectively studied 283 patients with head and neck carcinoma scheduled for radiotherapy between 2002 and 2010. We analyzed the influence of FDG-PET/CT versus CT alone on defining nodal target volume definition and evaluated its long-term clinical results. Second, the location of nodal recurrences was related to the radiation regional dose distribution.
In 92 patients, CT and FDG-PET, performed in mold, showed discordant results. In 33%, nodal staging was altered by FDG-PET. In 24%, FDG-PET also led to an alteration in nodal treatment, including a nodal upstage of 18% and downstage of 6%. In eight of these 92 patients, a regional recurrence occurred. Only two patients had a recurrence in the discordant node on FDG-PET and CT and both received a boost (high dose radiation).
These results support the complementary value of FDG-PET/CT compared to CT alone in defining nodal target volume definition for radiotherapy of head and neck cancer.
2-[F]-氟-2-脱氧-D-葡萄糖（FDG）-正电子发射断层扫描（PET）/计算机断层扫描（CT）在常规诊断分期中的作用仍存在争议。在FDG-PET与CT结果不一致的情况下，必须在FDG-PET假阳性风险和延迟适当挽救性干预风险之间做出权衡。其次，采用调强放射治疗（IMRT）时，较小的放射野可实现组织 sparing，但也可能导致更多边缘性失败。
我们回顾性研究了2002年至2010年间计划接受放疗的283例头颈癌患者。我们分析了FDG-PET/CT与单纯CT对确定淋巴结靶体积定义的影响，并评估了其长期临床结果。其次，淋巴结复发的位置与放射区域剂量分布相关。
在92例患者中，在模具中进行的CT和FDG-PET显示结果不一致。33%的患者淋巴结分期因FDG-PET而改变。24%的患者中，FDG-PET还导致淋巴结治疗改变，包括18%的淋巴结分期上调和6%的分期下调。在这92例患者中的8例出现了区域复发。只有2例患者在FDG-PET和CT检查结果不一致的淋巴结处复发，且均接受了加量照射（高剂量放疗）。
这些结果支持了与单纯CT相比，FDG-PET/CT在确定头颈癌放疗的淋巴结靶体积定义方面具有互补价值。
