Post-radiotherapy PET/CT for predicting treatment outcomes in head and neck cancer after postoperative radiotherapy

  • Yan Li
  • Musaddiq J. AwanEmail author
  • Tangel Chang
  • Pierre Lavertu
  • Chad Zender
  • Rod Rezaee
  • Nicole Fowler
  • Jay Wasman
  • Norbert E. Avril
  • Nianyong Chen
  • Mitchell Machtay
  • Min Yao
Original Article



The purpose of this study was to retrospectively review the role of post-treatment (post-tx) FDG-PET/CT scans in patients receiving postoperative intensity-modulated radiotherapy (IMRT) for head and neck squamous cell carcinomas (HNSCC).

Materials and methods

Eighty-two patients with HNSCC treated with surgery and postoperative IMRT with or without chemotherapy from October 15, 2008 to December 31, 2014 that had post-tx PET/CT within 6 months of completing IMRT were included. PET/CT was considered positive based on multi-disciplinary review integrating clinical information. Survival analysis was performed using the Kaplan-Meier method. Categorical and continuous predictors of positive post-tx PET/CT were evaluated using Fisher’s exact test and logistic regression, respectively. Predictors for survival outcomes were evaluated with log-rank testing. A p ≤ 0.05 was considered statistically significant.


Median follow-up was 3.88 years. For all patients, 3-year overall survival (OS) and recurrence-free survival (RFS) were 71.8% and 61.3%, respectively. Patients with positive post-tx PET/CT had worse OS compared to those with negative post-tx PET/CT (log rank p < 0.001). For patients with positive post-tx PET/CT, 3-year OS was 11.2% compared to 89.9% for patients with negative post-tx PET/CT. The positive predictive value (PPV) of PET/CT was 100% for local recurrence (LR), regional recurrence (RR) and distant metastasis (DM). The negative predictive values (NPV) for LR, RR and DM were 89.0%, 89.2%, and 85.9%, respectively. Perineural invasion (p = 0.009), p16 status (p = 0.009), non-oropharyngeal primary site (p = 0.002), and the use of chemotherapy (p = 0.01) were independent predictors of positive PET/CT.


Post-tx PET/CT after postoperative radiation is prognostic for survival outcomes. The PPV of post-tx PET for recurrence was excellent, allowing for early detection of recurrent disease. Post-tx PET/CT should be considered after postoperative radiation.


Head and neck cancer PET/CT Prognostic factors Postoperative radiotherapy 


Compliance with ethical standards

Conflict of interest

Yan Li MD has no conflicts of interest. Musaddiq J. Awan MD has no conflicts of interest. Tangel Chang D.O. has no conflicts of interest. Pierre Lavertu MD has no conflicts of interest. Chad Zender MD has no conflicts of interest. Rod Rezaee MD has no conflicts of interest. Nicole Fowler MD has no conflicts of interest. Jay Wasman MD has no conflicts of interest. Norbert Avril, MD has no conflicts of interest. Nianyong Chen, MD PhD has no conflicts of interest. Mitchell Machtay MD reports that he is a consultant for Bristol-Myers, Abbvie and Novocure. Min Yao MD PhD has no conflicts of interest.

Ethical approval

This is a retrospective, minimal risk study. Institutional review board approval was obtained for retrospective review of patient charts. This was performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yan Li
    • 1
  • Musaddiq J. Awan
    • 2
    Email author
  • Tangel Chang
    • 3
  • Pierre Lavertu
    • 4
  • Chad Zender
    • 4
  • Rod Rezaee
    • 4
  • Nicole Fowler
    • 4
  • Jay Wasman
    • 5
  • Norbert E. Avril
    • 6
  • Nianyong Chen
    • 1
  • Mitchell Machtay
    • 7
  • Min Yao
    • 7
  1. 1.Department of Radiation OncologyWest China Hospital of Sichuan UniversityChengduChina
  2. 2.Department of Radiation OncologyMedical College of WisconsinMilwaukeeUSA
  3. 3.Department of Radiation OncologyUniversity of ToledoToledoUSA
  4. 4.Department of Otolaryngology and Head and Neck SurgeryUniversity HospitalsClevelandUSA
  5. 5.Department of PathologyUniversity HospitalsClevelandUSA
  6. 6.Department of Nuclear Medicine and RadiologyUniversity HospitalsClevelandUSA
  7. 7.Department of Radiation OncologyCase Western Reserve University and University HospitalsClevelandUSA

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