Department of ORL - Head & Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Eur J Nucl Med Mol Imaging. 2018 Apr;45(4):613-621. doi: 10.1007/s00259-017-3873-3. Epub 2017 Nov 10.
In patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC), we wanted to examine the differences in overall treatment decisions, i.e. curative versus palliative treatment intent, reached by a multidisciplinary team conference (MDTC) based on 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) or chest X-ray + MRI of the head and neck (CXR/MRI).
This was a prospective blinded cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were invited to participate. All included patients underwent CXR/MRI and PET/CT before diagnostic biopsy. An ordinary MDTC using all available imaging was conducted as per standard practice. After at least 3 months (to eliminate recall bias in the team), the first project MDTC was conducted, based on either CXR/MRI or PET/CT, and the tumor board drew conclusions regarding treatment. After an additional 3 months, a second project MDTC was conducted using the complementary imaging modality.
A total of 307 patients were included. Based on CXR/MRI, 303 patients (99%) were recommended for curative treatment and only four patients (1%) for palliative treatment. Based on PET/CT, the MDTC concluded that 278 (91%) patients were suitable for curative treatment and 29 (9%) patients for palliative treatment. The absolute difference of 8% was statistically significant (95% CI: 4.8%-11.5%, p < 0.001).
A PET/CT-based imaging strategy significantly changed the decisions regarding treatment intent made by a MDTC for patients diagnosed with HNSCC, when compared with the standard imaging strategy of CXR/MRI.
在新诊断的头颈部鳞状细胞癌（HNSCC）患者中，我们想研究多学科团队会议（MDTC）根据 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）或胸部 X 射线+头颈部磁共振成像（CXR/MRI）做出的总体治疗决策（即治愈性与姑息性治疗意图）的差异。
这是一项基于配对数据的前瞻性、盲法队列研究。连续邀请经组织学证实的原发性 HNSCC 患者参加。所有纳入的患者在诊断性活检前均接受 CXR/MRI 和 PET/CT 检查。根据标准实践，进行了包括所有可用影像学检查的普通 MDTC。至少 3 个月后（以消除团队的回忆偏差），根据 CXR/MRI 或 PET/CT 进行了第一次项目 MDTC，肿瘤委员会对治疗做出了结论。3 个月后，使用互补的成像方式进行了第二次项目 MDTC。
共纳入 307 例患者。根据 CXR/MRI，303 例（99%）患者被推荐进行治愈性治疗，仅 4 例（1%）患者进行姑息性治疗。根据 PET/CT，MDTC 得出的结论是 278 例（91%）患者适合进行治愈性治疗，29 例（9%）患者适合进行姑息性治疗。8%的绝对差异具有统计学意义（95%CI：4.8%-11.5%，p<0.001）。
与 CXR/MRI 的标准成像策略相比，基于 PET/CT 的成像策略显著改变了 MDTC 对诊断为 HNSCC 的患者的治疗意图决策。
