Impact of a second FDG PET scan before adjuvant therapy for the early detection of residual/relapsing tumours in high-risk patients with oral cavity cancer and pathological extracapsular spread

  • Chun-Ta Liao
  • Kang-Hsing Fan
  • Chien-Yu Lin
  • Hung-Ming Wang
  • Shiang-Fu Huang
  • I-How Chen
  • Chung-Jan Kang
  • Shu-Hang Ng
  • Chuen Hsueh
  • Li-Yu Lee
  • Chih-Hung Lin
  • Tzu-Chen Yen
Original Article

DOI: 10.1007/s00259-012-2103-2

Cite this article as:
Liao, CT., Fan, KH., Lin, CY. et al. Eur J Nucl Med Mol Imaging (2012) 39: 944. doi:10.1007/s00259-012-2103-2

Abstract

Purpose

Extracapsular spread (ECS) to the cervical lymph nodes is a major adverse prognostic factor in oral cavity squamous cell carcinoma (OSCC). We prospectively examined the value of FDG PET immediately before postoperative radiotherapy/concurrent chemoradiotherapy (pre-RT/CCRT PET) to detect residual/relapsing disease in the early postsurgical follow-up period in high-risk OSCC patients with ECS.

Methods

We examined 183 high-risk OSCC patients with ECS who underwent preoperative FDG PET/CT for staging purposes. Of these patients, 29 underwent a second pre-RT/CCRT FDG PET/CT scan. The clinical utility of the second FDG PET/CT was examined using Kaplan-Meier curve analysis.

Results

Patients who underwent the second FDG PET/CT scan had baseline clinicopathological characteristics similar to those who did not undergo a second scan. Of the patients who underwent the second scan, seven (24 %) had unexpected, newly discovered lesions. Five eventually died of the disease, and two had no evidence of recurrence after a change in RT field and dose. In an event-based analysis at 2 months, rates of neck control (6/29 vs. 6/154, p = 0.001), distant metastases (3/29 vs. 4/154, p = 0.046), and disease-free survival (7/29 vs. 10/154, p = 0.003) were significantly higher in patients who received a second PET scan than in those who did not. The second pre-RT/CCRT PET scan was of particular benefit for detecting new lesions in OSCC patients with both ECS and lymph node standardized uptake value (SUV) of ≥5.2 in the first PET scan.

Conclusion

The present findings support the clinical value of pre-RT/CCRT FDG PET for defining treatment strategy in OSCC patients with both ECS and high nodal SUV, even when FDG PET had already been performed during the initial staging work-up.

Keywords

Adjuvant radiotherapy FDG PET Oral cavity squamous cell carcinoma Survival Outcome 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Chun-Ta Liao
    • 1
    • 2
  • Kang-Hsing Fan
    • 2
    • 3
  • Chien-Yu Lin
    • 2
    • 3
  • Hung-Ming Wang
    • 2
    • 4
  • Shiang-Fu Huang
    • 1
    • 2
  • I-How Chen
    • 1
    • 2
  • Chung-Jan Kang
    • 1
    • 2
  • Shu-Hang Ng
    • 2
    • 5
  • Chuen Hsueh
    • 2
    • 6
  • Li-Yu Lee
    • 2
    • 6
  • Chih-Hung Lin
    • 2
    • 7
  • Tzu-Chen Yen
    • 2
    • 8
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, Republic of China
  2. 2.Head and Neck Oncology GroupChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, Republic of China
  3. 3.Department of Radiation OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, Republic of China
  4. 4.Department of Medical OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, Republic of China
  5. 5.Department of Diagnostic RadiologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, Republic of China
  6. 6.Department of PathologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, Republic of China
  7. 7.Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanRepublic of China
  8. 8.Department of Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan, Republic of China