Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden.
Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden.
Viruses. 2022 Jul 30;14(8):1693. doi: 10.3390/v14081693.
Human-papillomavirus (HPV)-positive tonsillar and base of tongue carcinomas (TSCC/BOTSCC) are rising in incidence and treatments with radiotherapy, chemoradiotherapy (RT/CRT), and neck dissections (NDs) have several side effects. Therefore, an improved selection of patients needing salvage NDs would be beneficial. We examined the prevalence and localisations of viable tumour cells in neck lymph nodes in patients post-RT/CRT, identified by fluorodeoxyglucose positron-emission tomography with computer-tomography (FDG PET-CT), with a focus on HPV-associated tumours. Patients with 217 TSCC/BOTSCC with tumours assessed for HPV-DNA and p16 undergoing FDG PET-CT 12 weeks after treatment and/or an ND were included. The FDG PET-CT data were compared with the findings in the pathology report after the ND. In total, 36/217 (17%) patients were selected for an ND due to positive findings in post-treatment FDG PET-CT. Of these, 35/36 were HPV-associated, 10/36 (28%) had viable tumour cells in the pathology reports of the neck specimen, and 8/10 (80%) were consistent with the FDG PET-CT findings, while 2/36 (5%) were missed by FDG PET-CT. We conclude that FDG PET-CT 12 weeks after RT/CRT is useful, but not completely reliable for finding all the metastases of HPV-associated TSCC/BOTSCC. Nonetheless, our data indicate that an ND could be more selectively guided by FDG PET-CT.
人乳头瘤病毒（HPV）阳性扁桃体和舌根癌（TSCC/BOTSCC）的发病率正在上升，放疗、放化疗（RT/CRT）和颈部清扫术（NDs）的治疗有多种副作用。因此，改善需要挽救性 NDs 的患者选择将是有益的。我们检查了 RT/CRT 后患者颈部淋巴结中通过氟脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（FDG PET-CT）识别的活肿瘤细胞的流行率和定位，重点关注 HPV 相关肿瘤。对 HPV-DNA 和 p16 进行评估的 217 例 TSCC/BOTSCC 患者进行了 FDG PET-CT 检查，在治疗后 12 周进行了 FDG PET-CT 检查，或者进行了 ND。将 FDG PET-CT 数据与 ND 后的病理报告结果进行比较。共有 36/217（17%）名患者因治疗后 FDG PET-CT 检查结果阳性而被选择进行 ND。其中，35/36 例与 HPV 相关，10/36（28%）例在颈部标本的病理报告中发现了活肿瘤细胞，其中 8/10（80%）例与 FDG PET-CT 检查结果一致，而 2/36（5%）例被 FDG PET-CT 检查遗漏。我们得出结论，RT/CRT 后 12 周的 FDG PET-CT 是有用的，但并非完全可靠，可以发现所有 HPV 相关 TSCC/BOTSCC 的转移。尽管如此，我们的数据表明，FDG PET-CT 可以更有选择性地指导 ND。
