Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Laryngoscope. 2020 Dec;130(12):E850-E857. doi: 10.1002/lary.28509. Epub 2020 Feb 14.
OBJECTIVES/HYPOTHESIS: For locally advanced oral squamous cell carcinoma (OSCC) treated by surgery and adjuvant therapy, consensus has yet to be reached on whether the optimal time to initiate surveillance positron emission tomography/computed tomography (PET/CT) scan is before or after adjuvant therapy. In this study, we characterize the utility of PET/CT scans obtained 3 months after adjuvant therapy.
PET/CT scans were obtained for 220 patients with stage III, IVA, or IVB OSCC who underwent resection followed by adjuvant radiotherapy or chemoradiotherapy.
Using the Neck Imaging Reporting and Data System, PET/CT scans were dichotomized as suspicious (primary or neck category ≥3, or distant lesion present) versus nonsuspicious. We then computed differences in locoregional progression, distant progression, and overall survival; positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity; and success rate of salvage.
Sixty-seven patients (30%) had suspicious PET/CT scans, which were significantly associated with local failure (hazard ratio [HR] 14.0, 95% confidence interval [CI] 7.3-26.6), distant failure (HR 18.4, 95% CI 9.6-35.3), and poorer overall survival (HR 9.5, 95% CI 5.0-17.9). Overall PPV, locoregional PPV, NPV, sensitivity, and specificity were 85%, 79%, 73%, 58%, and 92%, respectively. Among those with biopsy-confirmed progression, 37 patients (65%) underwent salvage therapy; four (11%) were without evidence of disease at last follow-up.
For locally advanced OSCC, PET/CT scan 3 months after adjuvant therapy is strongly predictive of disease recurrence and survival, demonstrating improved performance over postoperative imaging in previous studies. Following a suspicious post-adjuvant therapy PET/CT scan, cure of locoregional recurrence is possible but unlikely.
4 Laryngoscope, 2020.
目的/假设：对于接受手术和辅助治疗的局部晚期口腔鳞状细胞癌（OSCC），对于何时开始进行监测正电子发射断层扫描/计算机断层扫描（PET/CT）扫描最佳，目前仍未达成共识，是在辅助治疗之前还是之后。在这项研究中，我们对辅助治疗后 3 个月获得的 PET/CT 扫描的效用进行了描述。
对 220 例 III 期、IVA 期或 IVB 期 OSCC 患者进行了手术切除，然后接受辅助放疗或放化疗，对这些患者进行了 PET/CT 扫描。
使用颈部成像报告和数据系统（Neck Imaging Reporting and Data System），将 PET/CT 扫描分为可疑（原发或颈部分类≥3，或存在远处病变）与非可疑。然后计算局部进展、远处进展和总生存率的差异；阳性预测值（PPV）、阴性预测值（NPV）、敏感性和特异性；以及挽救性治疗的成功率。
67 例（30%）患者的 PET/CT 扫描结果可疑，与局部失败显著相关（危险比[HR]14.0，95%置信区间[CI]7.3-26.6）、远处失败（HR 18.4，95%CI 9.6-35.3）和总体生存率较差（HR 9.5，95%CI 5.0-17.9）。总体 PPV、局部 PPV、NPV、敏感性和特异性分别为 85%、79%、73%、58%和 92%。在经活检证实进展的患者中，有 37 例（65%）接受了挽救性治疗；4 例（11%）在最后一次随访时未发现疾病。
对于局部晚期 OSCC，辅助治疗后 3 个月的 PET/CT 扫描对疾病复发和生存具有很强的预测性，与之前研究中术后影像学相比，表现有所提高。在可疑的辅助治疗后 PET/CT 扫描后，局部区域复发的治愈是可能的，但不太可能。
4 级喉镜，2020 年。
