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PET‐CT vs contrast‐enhanced CT: What is the role for each after chemoradiation for advanced oropharyngeal cancer?
Author(s) -
Chen Amy Y.,
Vilaseca Isabel,
Hudgins Patricia A.,
Schuster David,
Halkar Ragheev
Publication year - 2006
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.20362
Subject(s) - medicine , positron emission tomography , radiology , pet ct , head and neck cancer , nuclear medicine , cancer , primary tumor , cervical cancer , standardized uptake value , prospective cohort study , radiation therapy , metastasis
Purpose. The aim of our study was to assess the utility of positron emission tomography (PET) and 2 fluoro‐2‐deoxy‐ D ‐glucose coupled with neck CT compared with contrast‐enhanced CT in predicting persistent cancer either at the primary site or cervical lymphatics in patients with oropharyngeal cancer treated with concurrent chemoradiation Methods. Thirty consecutive patients underwent clinical examination, PET‐CT, and contrast‐enhanced CT to assess response after the completion of the treatment. The outcome variable was positive tissue diagnosis or negative disease at 6 months. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the primary site as well as cervical disease. Results. Contrast‐enhanced CT alone showed the best accuracy in detecting disease at the primary site after treatment (85.7%). Accuracy in evaluating residual tumor in the cervical lymphatics for contrast‐enhanced CT and PET‐CT was 59.3% and 74.1%, respectively. For evaluating the neck, PET‐CT and contrast‐enhanced CT demonstrated 100% NPV, but the PPV was 36.3% and 26.6%, respectively. Conclusions. In this preliminary study, PET‐CT seems to be superior to contrast‐enhanced CT in predicting persistent disease in the neck after chemoradiation for oropharyngeal or unknown primary cancer, but not at the primary site. However, the possibility of a false‐positive result in the neck remains high, and thus overtreatment may result. Even more concerning are the false‐negative results. Larger, prospective studies will be important in defining the role of PET‐CT in obviating the need for salvage neck dissections after chemoradiation. © 2006 Wiley Periodicals, Inc. Head Neck 28:487–495, 2006