Clinical utility of ¹⁸F-FDG PET/CT for patients with recurrent head and neck squamous cell carcinoma

Abstract

Background: The accurate detection of distant metastases can facilitate appropriate treatment planning for patients with recurrent head and neck squamous cell carcinoma (HNSCC).

Objectives: We evaluated the role of ¹⁸F-FDG PET/CT for distant metastasis diagnosis and survival prediction in patients with recurrent HNSCC.

Materials and methods: This study included 95 consecutive patients with recurrent HNSCC and salvage treatments. McNemar’s test was used to compare the detection of distant metastasis at recurrence using ¹⁸F-FDG PET/CT and contrast-enhanced chest and neck CT, and bone scintigraphy.

Results: Thirty-two patients (34%) had distant metastases at recurrence. The sensitivity, specificity, accuracy, and positive and negative predictive values of ¹⁸F-FDG PET/CT for detecting chest and bone metastases were comparable to those of conventional imaging (p > .1). However, ¹⁸F-FDG PET/CT detected two additional distant metastatic lesions. After controlling for clinicopathological factors, a recurrent lesion with maximum standardized uptake value (SUV_max) >8.7 was identified as an independent predictor of poor overall survival (p = .001).

Conclusions and significance: ¹⁸F-FDG PET/CT or conventional imaging is comparable with regard to detecting distant metastases of recurrent HNSCC. However, ¹⁸F-FDG PET/CT may detect additional metastatic lesions in unusual distant sites and the recurrent lesion SUV_max may predict patient survival after salvage treatments.

Chinese abstract

背景：远处转移的准确检测可有助于复发性头颈部鳞状细胞癌（HNSCC）患者的适当治疗计划。

目的：我们评估了¹⁸F-FDG PET / CT对复发性HNSCC患者远处转移诊断和生存预测的作用。

材料与方法：本研究纳入95例复发HNSCC和抢救治疗的连续患者。 运用McNemar测试来比较使用¹⁸F-FDG PET / CT和反差增强的胸部和颈部CT以及骨闪烁扫描进行复发时远处转移的检测。

结果：32例患者（34％）复发时有远处转移。 ¹⁸F-FDG PET / CT检测胸部和骨转移的敏感性、特异性、准确性以及阳性和阴性预测值与常规成像相当（p> .1）。然而, ¹⁸F-FDG PET / CT检测到另外两个远处转移病灶。在控制临床病理因素后, 具最大标准摄取值（SUVmax）> 8.7的复发病灶被确定为总生存率较低的独立预测因子（p = .001）。

结论和意义：¹⁸F-FDG PET / CT或常规成像在检测复发性HNSCC的远处转移方面具有可比性。然而, ¹⁸F-FDG PET / CT可以检测异常远端部位的其他转移性病变。复发性病变SUVmax可以预防挽救治疗后患者的存活率。

Keywords:

• Recurrent head and neck squamous cell carcinoma
• distant metastasis
• ¹⁸F-FDG PET/CT
• SUV_max
• survival

Disclosure statement

The authors have declared no conflict of interest.