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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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Radiotherapy Head and neck PET/CT Chemoradiation Recurrence Oropharynx 

Notes

Funding

None.

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.

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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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