Helsen Nils, Roothans Dessie, Van Den Heuvel Bert, Van den Wyngaert Tim, Van den Weyngaert Danielle, Carp Laurens, Stroobants Sigrid
Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium.
PLoS One. 2017 Aug 3;12(8):e0182350. doi: 10.1371/journal.pone.0182350. eCollection 2017.
The aim of this study is to evaluate the diagnostic performance of FDG-PET/CT for the detection of residual disease after (chemo)radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and to evaluate the prognostic value of the FDG-PET/CT findings.
Patients with HNSCC who underwent FDG-PET/CT after (chemo)radiotherapy were studied retrospectively.
104 FDG-PET/CT-scans were performed at a median of 13.2 weeks post-treatment (5.4-19.0 weeks). The diagnostic performance was time dependent with decreasing sensitivity and slightly increasing specificity over time. Sensitivity, specificity, PPV and NPV at 9 months after imaging were 91%, 87%, 77% and 95%, respectively. In a logistic regression model, the odds of a correct FDG-PET/CT increased with 33% every additional week after end of therapy (p = 0.01) and accuracy plateaued after 11 weeks (97%; p<0.001). A complete response on FDG-PET/CT was associated with an overall survival benefit (50.7 versus 10.3 months; p<0.001). Residual disease on FDG-PET/CT increased the risk of death 8-fold (p<0.001).
FDG-PET/CT is able to detect residual disease after (chemo)radiotherapy, with an optimal time point for scanning between 11-12 weeks after therapy. However, a reevaluation is probably necessary 10-12 months after the FDG-PET/CT to detect late recurrences. In addition, FDG-PET/CT can guide decisions about neck dissection and identifies patients with poor prognosis.
本研究旨在评估氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）对头颈部鳞状细胞癌（HNSCC）患者放（化）疗后残留病灶的诊断效能，并评估FDG-PET/CT检查结果的预后价值。
对放（化）疗后接受FDG-PET/CT检查的HNSCC患者进行回顾性研究。
共进行了104次FDG-PET/CT扫描，治疗后中位时间为13.2周（5.4 - 19.0周）。诊断效能与时间相关，随着时间推移敏感性降低，特异性略有增加。成像后9个月时的敏感性、特异性、阳性预测值和阴性预测值分别为91%、87%、77%和95%。在逻辑回归模型中，治疗结束后每增加一周，FDG-PET/CT正确诊断的几率增加33%（p = 0.01），11周后准确性达到平台期（97%；p<0.001）。FDG-PET/CT上的完全缓解与总生存获益相关（50.7个月对10.3个月；p<0.001）。FDG-PET/CT上的残留病灶使死亡风险增加8倍（p<0.001）。
FDG-PET/CT能够检测放（化）疗后的残留病灶，最佳扫描时间点为治疗后11 - 12周。然而，可能需要在FDG-PET/CT检查后10 - 12个月进行重新评估以检测晚期复发。此外，FDG-PET/CT可指导颈部清扫决策并识别预后不良的患者。
