PET/CT prior to salvage surgery in recurrent head and neck squamous cell carcinoma

  • A. Nøhr
  • S. B. Gram
  • B. Charabi
  • J. F. Tvedskov
  • I. Wessel
  • J. Friborg
  • K. Håkansson
  • C. von Buchwald
  • B. M. Fischer
  • Jacob H. RasmussenEmail author
Head and Neck



The purpose of this study was to assess the use of 18F-FDG PET/CT scans for detecting distant metastases in patients with recurrent head and neck squamous cell carcinoma (HNSCC) and investigate the treatment and survival of patients with recurrence.


In this retrospective study, consecutive head and neck cancer patients referred for FDG PET/CT scan between 2012 and 2014 were included. Patient records were reviewed and only patients with recurrence of HNSCC were enrolled for further analysis. Information on distant metastases, surgery and survival was collected. A Kaplan–Meier analysis was used to report survival.


Overall 275 PET/CT scans were performed due to suspected recurrence, and in 166 scans (144 patients), recurrence of HNSCC was confirmed, making them eligible for further analysis. Distant metastases were revealed in 29.8% of the scans (n = 51) and the proportion of revealed metastases remained constant at approximately 30% each year. Although the number of performed scans increased twofold each year, there was no statistically significant change in the proportion of scans with distant metastasis (p = 0.55). The distant metastases were most often seen in the lungs (n = 44) and bone (n = 15). A few patients had widespread dissemination to other areas. Salvage surgery was performed following 81 of the 166 PET/CT scans. Seven of the patients who underwent salvage surgery had M-site oligo-metastases. Patients who underwent salvage surgery had a median survival of 22 months whereas patients not treated with salvage surgery had a median survival of 6 months. After 5 years, 21% of the patients selected for salvage surgery were alive.


Distant metastases occur frequently in patients with recurrent HNSCC disease and the proportion of revealed distant metastases remained the same (30%). Imaging with FDG PET/CT can be recommended in patients with recurrent HNSCC prior to putative salvage surgery.


Salvage surgery Squamous cell carcinoma Recurrence FDG PET/CT 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent

Informed consent is not required for this study under Danish law, but the data collection was approved by the Danish Data Protection agency.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67(1):7–30. CrossRefGoogle Scholar
  2. 2.
    Haines G 3rd (2013) Pathology of head and neck cancers I: epithelial and related tumors. In: Head and neck cancer: current perspectives, advances, and challenges, pp 257–287Google Scholar
  3. 3.
    Marur S, Forastiere AA, Lanier WL, Jopke TL, Sankey KD, Smith NM (2016) Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. Mayo Clin Proc 91:386–396. CrossRefGoogle Scholar
  4. 4.
    Cooper JS, Pajak TF, Forastiere AA et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. CrossRefGoogle Scholar
  5. 5.
    Tobias JS, Monson K, Gupta N et al (2010) Chemoradiotherapy for locally advanced head and neck cancer: 10-year follow-up of the UK Head and Neck (UKHAN1) trial. Lancet Oncol 11(1):66–74. CrossRefGoogle Scholar
  6. 6.
    Chang J-H, Wu C-C, Sheng K, Yuan -Po, Wu ATH, Wu S-Y (2017) Locoregionally recurrent head and neck squamous cell carcinoma: incidence, survival, prognostic factors, and treatment outcomes. Oncotarget 8(33):55600–55612. Accessed 19 Feb 2018
  7. 7.
    Patel SN, Cohen MA, Givi B et al (2016) Salvage surgery for locally recurrent oropharyngeal cancer. Head Neck 38(S1):E658–E664. CrossRefGoogle Scholar
  8. 8.
    Zafereo ME, Hanasono MM, Rosenthal DI et al (2009) The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx. Cancer 115(24):5723–5733. CrossRefGoogle Scholar
  9. 9.
    Lonneux M, Hamoir M, Reychler H et al (2010) Positron emission tomography with [18F]Fluorodeoxyglucose improves staging and patient management in patients with head and neck squamous cell carcinoma: a multicenter prospective study. J Clin Oncol 28(7):1190–1195. CrossRefGoogle Scholar
  10. 10.
    Cacicedo J, Fernandez I, del Hoyo O et al (2015) Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis. Eur J Nucl Med Mol Imaging 42(9):1378–1389. CrossRefGoogle Scholar
  11. 11.
    Johansen J, Buus S, Loft A et al (2008) Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor: results from the DAHANCA-13 study. Head Neck 30(4):471–478. CrossRefGoogle Scholar
  12. 12.
    Cacicedo J, Navarro A, del Hoyo O et al (2016) Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol 89(1067):20160217. CrossRefGoogle Scholar
  13. 13.
    Troost EGC, Schinagl DAX, Bussink J, Oyen WJG, Kaanders JHAM (2010) Clinical evidence on PET-CT for radiation therapy planning in head and neck tumours. Radiother Oncol 96(3):328–334. CrossRefGoogle Scholar
  14. 14.
    Bentzen SM, Gregoire V (2011) Molecular imaging-based dose painting: a novel paradigm for radiation therapy prescription. Semin Radiat Oncol 21(2):101–110. CrossRefGoogle Scholar
  15. 15.
    Mehanna H, Wong W-L, McConkey CC et al (2016) PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med 374(15):1444–1454. CrossRefGoogle Scholar
  16. 16.
  17. 17.
    Yoo J, Henderson S, Walker-Dilks C (2013) Evidence-based guideline recommendations on the use of positron emission tomography imaging in head and neck cancer. Clin Oncol 25:e33–e66. CrossRefGoogle Scholar
  18. 18.
    Wong WL, Ross P, Corcoran M (2013) Evidence-based guideline recommendations on the use of positron emission tomography imaging in head and neck cancer from ontario and guidelines in general-some observations. Clin Oncol 25:242–245. CrossRefGoogle Scholar
  19. 19.
    Fakhry N, Michel J, Colavolpe C, Varoquaux A, Dessi P, Giovanni A (2012) Screening for distant metastases before salvage surgery in patients with recurrent head and neck squamous cell carcinoma: a retrospective case series comparing thoraco-abdominal CT, positron emission tomography and abdominal ultrasound. Clin Otolaryngol 37(3):197–206. CrossRefGoogle Scholar
  20. 20.
    Yi JS, Kim JS, Lee JH et al (2012) 18 F-FDG PET/CT for detecting distant metastases in patients with recurrent head and neck squamous cell carcinoma. J Surg Oncol 106(6):708–712. CrossRefGoogle Scholar
  21. 21.
    Ryu IS, Roh J-L, Kim JS et al (2016) Impact of (18)F-FDG PET/CT staging on management and prognostic stratification in head and neck squamous cell carcinoma: a prospective observational study. Eur J Cancer 63:88–96. CrossRefGoogle Scholar
  22. 22.
    Brouwer J, de Bree R, Hoekstra OS et al (2005) Screening for distant metastases in patients with head and neck cancer: is chest computed tomography sufficient? Laryngoscope 115(10):1813–1817. CrossRefGoogle Scholar
  23. 23.
    Ng S-H, Chan S-C, Yen T-C et al (2010) Comprehensive imaging of residual/recurrent nasopharyngeal carcinoma using whole-body MRI at 3 T compared with FDG-PET-CT. Eur Radiol 20(9):2229–2240. CrossRefGoogle Scholar
  24. 24.
    Gourin CG, Watts T, Williams HT, Patel VS, Bilodeau PA, Coleman TA (2009) Identification of distant metastases with PET-CT in patients with suspected recurrent head and neck cancer. Laryngoscope 119(4):703–706. CrossRefGoogle Scholar
  25. 25.
    Perlow A, Bui C, Shreve P, Sundgren PC, Teknos TN, Mukherji SK (2004) High incidence of chest malignancy detected by FDG PET in patients suspected of recurrent squamous cell carcinoma of the upper aerodigestive tract. J Comput Assist Tomogr 28(5):704–709. CrossRefGoogle Scholar
  26. 26.
    Rohde M, Nielsen AL, Johansen J et al (2017) Head-to-Head comparison of chest X-ray/head and neck MRI, chest CT/head and neck MRI, and 18F-FDG PET/CT for detection of distant metastases and synchronous cancer in oral, pharyngeal, and laryngeal cancer. J Nucl Med 58(12):1919–1924. CrossRefGoogle Scholar
  27. 27.
    Kim SY, Roh J-L, Yeo N-K et al (2007) Combined 18F-fluorodeoxyglucose-positron emission tomography and computed tomography as a primary screening method for detecting second primary cancers and distant metastases in patients with head and neck cancer. Ann Oncol Off J Eur Soc Med Oncol 18(10):1698–1703. CrossRefGoogle Scholar
  28. 28.
    Xu G, Li J, Zuo X, Li C (2012) Comparison of whole body positron emission tomography (PET)/PET-computed tomography and conventional anatomic imaging for detecting distant malignancies in patients with head and neck cancer: a meta-analysis. Laryngoscope 122(9):1974–1978. CrossRefGoogle Scholar
  29. 29.
    Xu G-Z, Guan D-J, He Z-Y (2011) 18FDG-PET/CT for detecting distant metastases and second primary cancers in patients with head and neck cancer. A meta-analysis. Oral Oncol 47(7):560–565. CrossRefGoogle Scholar
  30. 30.
    Gao S, Li S, Yang X, Tang Q (2014) Review 18 FDG PET-CT for distant metastases in patients with recurrent head and neck cancer after definitive treatment. A meta-analysis. Oral Oncol 50:163–167. CrossRefGoogle Scholar
  31. 31.
    Goodwin WJ (2000) Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope 110(S93):1–18. CrossRefGoogle Scholar
  32. 32.
    Guo T, Qualliotine JR, Ha PK et al (2015) Surgical salvage improves overall survival for patients with HPV-positive and HPV-negative recurrent locoregional and distant metastatic oropharyngeal cancer. Cancer 121(12):1977–1984. CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Oncology, Section of Radiotherapy, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Clinical Physiology, Nuclear Medicine and PET, PET and Cyclotron Unit, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  4. 4.The Pet Centre, School of Biomedical Engineering and Imaging SciencesKCL St Thomas’ HospitalLondonUK

Personalised recommendations