European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 5, pp 1447–1455 | Cite as

FDG-PET/CT improves detection of residual disease and reduces the need for examination under anaesthesia in oropharyngeal cancer patients treated with (chemo-)radiation

  • Mischa de Ridder
  • Zeno A. R. Gouw
  • Arash Navran
  • Olga Hamming-Vrieze
  • Bas Jasperse
  • Michiel W. M. van den Brekel
  • Wouter V. Vogel
  • A. Al-MamganiEmail author
Head & Neck



Early detection of residual disease (RD) after (chemo)radiation for oropharyngeal (OPC) is crucial. Surveillance of neck nodes with FDG-PET/CT has been studied extensively, whereas its value for local RD remains less clear. We aim to evaluate the diagnostic value of post-treatment FDG-PET/CT in detecting local RD and the outcome of patients with local RD.


A cohort (n = 352) of consecutively treated OPC patients at our institute between 2010 and 2017 was evaluated. Patients that underwent FDG-PET/CT at 3 months post-treatment (n = 94) were classified as having complete (CMR) or partial metabolic response (PMR). PMR was defined as visually detectable metabolic activity above the background of surrounding normal tissues. Primary endpoint was diagnostic accuracy in detecting local RD.


Local RD was seen in 19/352 patients (5%), all of them were HPV negative. The FDG-PET/CT had a sensitivity of 100% (8/8), specificity 85% (73/86), PPV 38% (8/21), NPV 100% (73/73), and accuracy 86%. Patients with local RD had significantly worse OS at 2 years, compared to those without (10 versus 88%, P < 0.001). In multivariable analysis, local RD remained a significant predictive factor for death with a hazard ratio of 11.9 (95% CI 5.8–24.3). The number of patients that underwent PET/CT increased over time (P < 0.001), whereas the number of patients that underwent EUA declined (P = 0.072).


FDG-PET/CT has excellent performance for the detection of RD, with the sensitivity and negative predictive value approaching 100%. Due to these excellent results is examination under anaesthesia today in the vast majority of the PET-negative cases not necessary anymore.


Radiotherapy Head and neck PET/CT Chemoradiation Recurrence Oropharynx 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

The local IRB waived informed consent for this retrospective analysis of clinical data.


  1. 1.
    Pignon JP, Bourhis J, Domenge C, Designe L (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet 355(9208):949–955CrossRefGoogle Scholar
  2. 2.
    Pignon JP, le Maitre A, Maillard E, Bourhis J, Group M-NC (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92(1):4–14. CrossRefGoogle Scholar
  3. 3.
    Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK (2006) Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 354(6):567–578. CrossRefGoogle Scholar
  4. 4.
    de Ridder M, Gouw ZAR, Sonke JJ, Navran A, Jasperse B, Heukelom J, Tesselaar MET, Klop WMC, van den Brekel MWM, Al-Mamgani A (2017) Recurrent oropharyngeal cancer after organ preserving treatment: pattern of failure and survival. Eur Arch Otorhinolaryngol 274(3):1691–1700. CrossRefPubMedGoogle Scholar
  5. 5.
    Mehanna H, Wong WL, McConkey CC, Rahman JK, Robinson M, Hartley AG, Nutting C, Powell N, Al-Booz H, Robinson M, Junor E, Rizwanullah M, von Zeidler SV, Wieshmann H, Hulme C, Smith AF, Hall P, Dunn J, Group P-NTM (2016) PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med 374(15):1444–1454. CrossRefGoogle Scholar
  6. 6.
    Ojiri H, Mendenhall WM, Mancuso AA (2002) CT findings at the primary site of oropharyngeal squamous cell carcinoma within 6–8 weeks after definitive radiotherapy as predictors of primary site control. Int J Radiat Oncol Biol Phys 52(3):748–754CrossRefPubMedGoogle Scholar
  7. 7.
    Gupta T, Master Z, Kannan S, Agarwal JP, Ghsoh-Laskar S, Rangarajan V, Murthy V, Budrukkar A (2011) Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 38(11):2083–2095. CrossRefGoogle Scholar
  8. 8.
    Bird T, Barrington S, Thavaraj S, Jeannon JP, Lyons A, Oakley R, Simo R, Lei M, Guerrero Urbano T (2016) (18)F-FDG PET/CT to assess response and guide risk-stratified follow-up after chemoradiotherapy for oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 43(7):1239–1247. CrossRefPubMedGoogle Scholar
  9. 9.
    Chen AY, Vilaseca I, Hudgins PA, Schuster D, Halkar R (2006) PET-CT vs contrast-enhanced CT: what is the role for each after chemoradiation for advanced oropharyngeal cancer? Head Neck 28(6):487–495. CrossRefPubMedGoogle Scholar
  10. 10.
    Katsuura T, Kitajima K, Fujiwara M, Terada T, Uwa N, Noguchi K, Doi H, Tamaki Y, Yoshida R, Tsuchitani T, Fujita M, Yamakado K (2018) Assessment of tumor response to chemoradiotherapy and predicting prognosis in patients with head and neck squamous cell carcinoma by PERCIST. Ann Nucl Med 32(7):453–462. CrossRefPubMedGoogle Scholar
  11. 11.
    Koshkareva Y, Branstetter BFT, Gaughan JP, Ferris RL (2014) Predictive accuracy of first post-treatment PET/CT in HPV-related oropharyngeal squamous cell carcinoma. Laryngoscope 124(8):1843–1847. CrossRefPubMedGoogle Scholar
  12. 12.
    Suenaga Y, Kitajima K, Ishihara T, Sasaki R, Otsuki N, Nibu K, Minamikawa T, Kiyota N, Sugimura K (2016) FDG-PET/contrast-enhanced CT as a post-treatment tool in head and neck squamous cell carcinoma: comparison with FDG-PET/non-contrast-enhanced CT and contrast-enhanced CT. Eur Radiol 26(4):1018–1030. CrossRefPubMedGoogle Scholar
  13. 13.
    Taghipour M, Mena E, Kruse MJ, Sheikhbahaei S, Subramaniam RM (2017) Post-treatment 18F-FDG-PET/CT versus contrast-enhanced CT in patients with oropharyngeal squamous cell carcinoma: comparative effectiveness study. Nucl Med Commun 38(3):250–258. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Vainshtein JM, Spector ME, Stenmark MH, Bradford CR, Wolf GT, Worden FP, Chepeha DB, McHugh JB, Carey T, Wong KK, Eisbruch A (2014) Reliability of post-chemoradiotherapy F-18-FDG PET/CT for prediction of locoregional failure in human papillomavirus-associated oropharyngeal cancer. Oral Oncol 50(3):234–239. CrossRefPubMedGoogle Scholar
  15. 15.
    Greven KM, Williams III DW, McGuirt Sr WF, Harkness BA, D’Agostino RB Jr, Keyes JW Jr, Watson NE Jr (2001) Serial positron emission tomography scans following radiation therapy of patients with head and neck cancer. Head Neck 23(11):942–946CrossRefPubMedGoogle Scholar
  16. 16.
    McDermott M, Hughes M, Rath T, Johnson JT, Heron DE, Kubicek GJ, Kim SW, Ferris RL, Duvvuri U, Ohr JP, Branstetter BF (2013) Negative predictive value of surveillance PET/CT in head and neck squamous cell cancer. AJNR Am J Neuroradiol 34(8):1632–1636. CrossRefPubMedGoogle Scholar
  17. 17.
    Bahadur S, Amatya RC, Kacker SK (1985) The enigma of post-radiation oedema and residual or recurrent carcinoma of the larynx and pyriform fossa. J Laryngol Otol 99(8):763–765CrossRefPubMedGoogle Scholar
  18. 18.
    Olteanu LAM, Duprez F, De Neve W, Berwouts D, Vercauteren T, Bauters W, Deron P, Huvenne W, Bonte K, Goethals I, Schatteman J, De Gersem W (2018) Late mucosal ulcers in dose-escalated adaptive dose-painting treatments for head-and-neck cancer. Acta Oncol 57(2):262–268. CrossRefPubMedGoogle Scholar
  19. 19.
    Greuter MJ, Schouten CS, Castelijns JA, de Graaf P, Comans EF, Hoekstra OS, de Bree R, Coupe VM (2017) Cost-effectiveness of response evaluation after chemoradiation in patients with advanced oropharyngeal cancer using (18)F-FDG-PET-CT and/or diffusion-weighted MRI. BMC Cancer 17(1):256. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ng SP, Johnson JM, Gunn GB, Rosenthal DI, Skinner HD, Phan J, Frank SJ, Morrison W, Sturgis EM, Mott FE, Williams MD, Fuller CD, Garden AS (2018) Significance of negative posttreatment 18-FDG PET/CT imaging in patients with p16/HPV-positive oropharyngeal cancer. Int J Radiat Oncol Biol Phys. CrossRefPubMedGoogle Scholar
  21. 21.
    Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363(1):24–35. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Gouw ZAR, Jasperse B, Sonke JJ, Heemsbergen WD, Navran A, Hamming-Vrieze O, de Boer JP, van den Brekel MWM, Al-Mamgani A (2017) A predictive model for residual disease after (chemo)radiotherapy in oropharyngeal carcinoma: Combined radiological and clinical evaluation of tumor response. Clin Transl Radiat Oncol 6:1–6CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Mischa de Ridder
    • 1
    • 2
  • Zeno A. R. Gouw
    • 1
  • Arash Navran
    • 1
  • Olga Hamming-Vrieze
    • 1
  • Bas Jasperse
    • 3
  • Michiel W. M. van den Brekel
    • 4
    • 5
  • Wouter V. Vogel
    • 1
    • 6
  • A. Al-Mamgani
    • 1
    Email author
  1. 1.Department of Radiation OncologyAntoni van Leeuwenhoek – Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Department of Radiation OncologyVerbeeten InstituutTilburgThe Netherlands
  3. 3.Department of RadiologyAntoni van Leeuwenhoek/Netherlands Cancer Institute AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Head and Neck SurgeryAntoni van Leeuwenhoek/Netherlands Cancer Institute AmsterdamAmsterdamThe Netherlands
  5. 5.Amsterdam UMC, Department of Maxillo-facial SurgeryUniversity of AmsterdamAmsterdamThe Netherlands
  6. 6.Department of Nuclear MedicineAntoni van Leeuwenhoek/Netherlands Cancer Institute AmsterdamAmsterdamThe Netherlands

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