Is FDG -PET-CT A Valuable Tool in Prediction of Persistent Disease in Head and Neck Cancer

  • Uzel, Esengul Kocak (Radiation Oncology, Sisli Etfal Teaching and Research Hospital) ;
  • Ekmekcioglu, Ozgul (Nuclear Medicine, Cerrahpasa Medical Faculty) ;
  • Elicin, Olgun (Radiation Oncology, Cerrahpasa Medical Faculty) ;
  • Halac, Metin (Nuclear Medicine, Cerrahpasa Medical Faculty) ;
  • Uzel, Omer Erol (Radiation Oncology, Cerrahpasa Medical Faculty)
  • Published : 2013.08.30


Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.


PET-CT;head and neck cancer;nasopharyngeal cancer;response evaluation;SUV


  1. Andrade RS, Heron DE, Degirmenci B, et al (2006). Post-treatment assessment of response using FDG-PET/CT for patients treated with definitive radiation therapy for head and neck cancers. Int J Radiat Oncol Biol Phys, 65, 1315-22.
  2. Bastiaannet E, Groen H, Jager PL, et al (2004). The value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomas: A systematic review and meta-analysis. Cancer Treat Rev, 30, 83-101.
  3. De Santis M, Becherer A, Bokemeyer C, et al (2004). 2-[18]Fluoro- deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: An update of the prospective multicentric SEMPET trial. J Clin Oncol, 22, 1034-9.
  4. Ding M, Newman F, Raben D (2005). New radiation therapy techniques for the treatment of head and neck cancer. Otolaryngol Clin North Am, 38, 371-95.
  5. Eisbruch A, Marsh LH, Dawson LA, et al (2004). Recurrences near base of skull after IMRT for head-and-neck cancer: Implica- tions for target delineation in high neck and for parotid gland sparing. Int J Radiat Oncol Biol Phys, 59, 28-42.
  6. El-Sayed S, Nelson N (1996). Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and random- ized trials. J Clin Oncol, 14, 838-47.
  7. Hain SF, O'Doherty MJ, Timothy AR, et al (2000). Fluorodeoxyglucose PET in the initial staging of germ cell tumours. Eur J Nucl Med, 27, 590-4
  8. HigginsKA, Hoang JK, Roach MC, et al (2012). Analysis of Pretreatment FDG-PET SUV parameters in Head-and-Neck Cancer: Tumor SUVmean has superior prognostic value. Int J Radiat Oncol Biol Phys, 82, 548-53
  9. Kaplan EL, Meier P (1958). Nonparametric estimation from incomplete observations. J Am Statist Assoc, 53, 457-81
  10. Lee N, Xia P, Fischbein NJ, (2003). Intensity-modulated radiation therapy for head-and-neck cancer: The UCSF experience focusing on target volume delineation. Int J Radiat Oncol Biol Phys, 57, 49-60.
  11. Lefebvre JL, Chevalier D, Luboinski B, et al (1996). Larynx preservation in pyriform sinus cancer: Preliminary results of a Eu- ropean Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst, 88, 890-9.
  12. Mantel N (1966). Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chem Rep, 5, 163-70
  13. Moeller BJ, Rana V, Cannon BA, et al (2009). Prospective risk-adjuste [18F]Fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. J Clin Oncol, 20, 2509-15.
  14. Murphy JD, La TH, Chu K, et al (2011). Postradiation metabolic tumor volume predicts outcome in head-and-neck cancer. Int J Radiat Oncol Biol Phys, 80, 514-21.
  15. Paccagnella A, Orlando A, Marchiori C, et al (1994). Phase III trial of initial chemotherapy in Stage III or IV head and neck cancers: A study by the Gruppo di Studio sui Tumori della Testa e del Collo. J Natl Cancer Inst, 86, 265-72.
  16. Paola Castaldi,Vittoria Rufini,Francesco Bussu, et al (2012). Can early and late 18F-FDG PET.CT be used as prognostic factors.for the clinical outcome of patients with locally advanced head and neck cancer treated with radio-chemotherapy? Radiother Oncol, 3, 63-8.
  17. Passero VA, Branstetter BF, Shuai Y, et al (2010). Response assessment by combined PET-CT scan versus CT scan alone using RECIST in patients with locally advanced head and neck cancer treated with chemoradiotherapy. Ann Oncol, 21, 2278-83
  18. Pfister DG, Shaha AR, Harrison LB (1997). The role of chemotherapy in the curative treatment of head and neck cancer. Surg Oncol Clin N Am, 6, 749-68
  19. Pignon JP, le Maitre A, Maillard E, Bourhis J, (2009). Meta-analysis of chemo- therapy in head and neck cancer (MACH-NC): An update on 93 randomised trials and 17, 346 patients. Radiother Oncol, 92, 4-14.
  20. Prestwich RJ, Subesinghe M, Gilbert A, et al (2012). Delayed response assessment with FDG-PET-CT following (chemo) radiotherapy for locally advanced head and neck squamous cell carcinoma. Clin Radiol, 67, 966-75.
  21. Rose PG, Adler LP, Rodriguez M, et al (1999). Positron emission tomography for evaluating paraaortic nodal metastasis in locally advanced cervical cancer before surgical staging: A surgicopathologic study. J Clin Oncol, 17, 41-5.
  22. Scarfone C, Lavely WC, Cmelak AJ, et al (2004). Prospective feasibil- ity trial of radiotherapy target definition for head and neck can- cer using 3-dimensional PET and CT imaging. J Nucl Med, 45, 543-52.
  23. Schwartz DL, Ford E, Rajendran J, et al (2005). FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys, 61, 129-36.
  24. Trautmann TG, Zuger JH, (2005). Positron Emission Tomography for Pretreatment Staging and Posttreatment Evaluation in Cancer of the Anal Canal: Mol Imaging Biol, 7, 309-13.
  25. Troost EG, Schinagl DA, Bussink J, Oyen WJ, Kaanders JH (2010). Clinical evidence on PET-CT for radiation therapy planning in head and neck tumours. Radiother Oncol, 96, 328-34.
  26. Wong RJ, Lin DT, Schoder H et al (2002). Diagnostic and Prognostic Value of [18F]Fluorodeoxyglucose Positron Emission Tomography for Recurrent Head and Neck Squamous Cell Carcinoma. J Clin Oncol, 20, 4199-208.
  27. Yanagawa M, Tatsumi M, Miyata H, et al (2012). Evaluation of Response to Neoadjuvant Chemotherapy for Esophageal Cancer: PET Response Criteria in Solid Tumors Versus Response Evaluation Criteria in Solid Tumors. J Nucl Med, 53, 872-80.
  28. Yao M, Smith RB, Graham MM, et al (2005). The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment. Int J Radiat Oncol Biol Phys, 63, 991-9

Cited by

  1. Standardized Uptake Values Highly Correlate with Tumor Size and Fuhrman Grade in Patients with Clear Cell Renal Cell Carcinoma vol.15, pp.18, 2014,
  2. Risk of Cancer Mortality according to the Metabolic Health Status and Degree of Obesity vol.15, pp.22, 2014,
  3. Diagnostic Accuracy of 18F-FDG-PET in Patients with Testicular Cancer: a Meta-analysis vol.15, pp.8, 2014,