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Outcomes and Predictive Value of Post‐adjuvant Therapy PET/CT for Locally Advanced Oral Squamous Cell Carcinoma
Author(s) -
Qian David C.,
Magliocca Kelly R.,
Aiken Ashley H.,
Baug Kristen L.,
Brandon David C.,
Stokes William A.,
McDonald Mark W.,
Patel Mihir R.,
Baddour Harry M.,
Kaka Azeem S.,
Steuer Conor E.,
Saba Nabil F.,
Shin Dong M.,
Beitler Jonathan J.
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28509
Subject(s) - medicine , hazard ratio , positron emission tomography , salvage therapy , stage (stratigraphy) , adjuvant therapy , radiology , chemoradiotherapy , radiation therapy , confidence interval , adjuvant , pet ct , nuclear medicine , chemotherapy , paleontology , biology
Objectives/Hypothesis For locally advanced oral squamous cell carcinoma (OSCC) treated by surgery and adjuvant therapy, consensus has yet to be reached on whether the optimal time to initiate surveillance positron emission tomography/computed tomography (PET/CT) scan is before or after adjuvant therapy. In this study, we characterize the utility of PET/CT scans obtained 3 months after adjuvant therapy. Study Design PET/CT scans were obtained for 220 patients with stage III, IVA, or IVB OSCC who underwent resection followed by adjuvant radiotherapy or chemoradiotherapy. Methods Using the Neck Imaging Reporting and Data System, PET/CT scans were dichotomized as suspicious (primary or neck category ≥3, or distant lesion present) versus nonsuspicious. We then computed differences in locoregional progression, distant progression, and overall survival; positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity; and success rate of salvage. Results Sixty‐seven patients (30%) had suspicious PET/CT scans, which were significantly associated with local failure (hazard ratio [HR] 14.0, 95% confidence interval [CI] 7.3–26.6), distant failure (HR 18.4, 95% CI 9.6–35.3), and poorer overall survival (HR 9.5, 95% CI 5.0–17.9). Overall PPV, locoregional PPV, NPV, sensitivity, and specificity were 85%, 79%, 73%, 58%, and 92%, respectively. Among those with biopsy‐confirmed progression, 37 patients (65%) underwent salvage therapy; four (11%) were without evidence of disease at last follow‐up. Conclusions For locally advanced OSCC, PET/CT scan 3 months after adjuvant therapy is strongly predictive of disease recurrence and survival, demonstrating improved performance over postoperative imaging in previous studies. Following a suspicious post‐adjuvant therapy PET/CT scan, cure of locoregional recurrence is possible but unlikely. Level of Evidence 4 Laryngoscope , 2020