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Up-front PET/CT changes treatment intent in patients with head and neck squamous cell carcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC), we wanted to examine the differences in overall treatment decisions, i.e. curative versus palliative treatment intent, reached by a multidisciplinary team conference (MDTC) based on 18F–fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) or chest X-ray + MRI of the head and neck (CXR/MRI).

Patients and methods

This was a prospective blinded cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were invited to participate. All included patients underwent CXR/MRI and PET/CT before diagnostic biopsy. An ordinary MDTC using all available imaging was conducted as per standard practice. After at least 3 months (to eliminate recall bias in the team), the first project MDTC was conducted, based on either CXR/MRI or PET/CT, and the tumor board drew conclusions regarding treatment. After an additional 3 months, a second project MDTC was conducted using the complementary imaging modality.

Results

A total of 307 patients were included. Based on CXR/MRI, 303 patients (99%) were recommended for curative treatment and only four patients (1%) for palliative treatment. Based on PET/CT, the MDTC concluded that 278 (91%) patients were suitable for curative treatment and 29 (9%) patients for palliative treatment. The absolute difference of 8% was statistically significant (95% CI: 4.8%–11.5%, p < 0.001).

Conclusions

A PET/CT-based imaging strategy significantly changed the decisions regarding treatment intent made by a MDTC for patients diagnosed with HNSCC, when compared with the standard imaging strategy of CXR/MRI.

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References

  1. Rohde M, Dyrvig AK, Johansen J, Sorensen JA, Gerke O, Nielsen AL, et al. 18F–fluoro-deoxy-glucose-positron emission tomography/computed tomography in diagnosis of head and neck squamous cell carcinoma: a systematic review and meta-analysis. Europe J Cancer (Oxford, England : 1990). 2014;50:2271–9. https://doi.org/10.1016/j.ejca.2014.05.015.

    Google Scholar 

  2. Lonneux M, Hamoir M, Reychler H, Maingon P, Duvillard C, Calais G, et al. 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 : Off J Am Soc Clin Oncol. 2010;28:1190–5. https://doi.org/10.1200/jco.2009.24.6298.

    Article  CAS  Google Scholar 

  3. Yoo J, Henderson S, Walker-Dilks C. Evidence-based guideline recommendations on the use of positron emission tomography imaging in head and neck cancer. Clin Oncol (Royal College of Radiologists (Great Britain)). 2013;25:e33–66. https://doi.org/10.1016/j.clon.2012.08.007.

    Article  CAS  Google Scholar 

  4. Cacicedo J, Fernandez I, Del Hoyo O, Dolado A, Gomez-Suarez J, Hortelano E, et al. 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. 2015;42:1378–89. https://doi.org/10.1007/s00259-015-3071-0.

    Article  PubMed  Google Scholar 

  5. Senft A, de Bree R, Hoekstra OS, Kuik DJ, Golding RP, Oyen WJ, et al. Screening for distant metastases in head and neck cancer patients by chest CT or whole body FDG-PET: a prospective multicenter trial. Radiother Oncol. 2008;87:221–9. https://doi.org/10.1016/j.radonc.2008.03.008.

    Article  PubMed  Google Scholar 

  6. Haerle SK, Schmid DT, Ahmad N, Hany TF, Stoeckli SJ. The value of (18)F-FDG PET/CT for the detection of distant metastases in high-risk patients with head and neck squamous cell carcinoma. Oral Oncol. 2011;47:653–9. https://doi.org/10.1016/j.oraloncology.2011.05.011.

    Article  PubMed  Google Scholar 

  7. Xu GZ, Guan DJ, He ZY. (18)FDG-PET/CT for detecting distant metastases and second primary cancers in patients with head and neck cancer. A meta-analysis. Oral Oncol. 2011;47:560–5. https://doi.org/10.1016/j.oraloncology.2011.04.021.

    Article  PubMed  Google Scholar 

  8. Johansen J, Petersen H, Godballe C, Loft A, Grau C. FDG-PET/CT for detection of the unknown primary head and neck tumor. Quarter J Nucl Med Molec Imaging. 2011;55:500–8.

    CAS  Google Scholar 

  9. Krabbe CA, Pruim J, van der Laan BF, Rodiger LA, Roodenburg JL. FDG-PET and detection of distant metastases and simultaneous tumors in head and neck squamous cell carcinoma: a comparison with chest radiography and chest CT. Oral Oncol. 2009;45:234–40. https://doi.org/10.1016/j.oraloncology.2008.05.024.

    Article  PubMed  Google Scholar 

  10. Kim SY, Roh JL, Yeo NK, Kim JS, Lee JH, Choi SH, et al. 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. 2007;18:1698–703. https://doi.org/10.1093/annonc/mdm270.

    Article  CAS  PubMed  Google Scholar 

  11. Gregoire V, Lefebvre JL, Licitra L, Felip E. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21:v184–v6.

    Article  PubMed  Google Scholar 

  12. Scott AM, Gunawardana DH, Bartholomeusz D, Ramshaw JE, Lin P. PET changes management and improves prognostic stratification in patients with head and neck cancer: results of a multicenter prospective study. J Nuclear Med : Off Publ, Soc Nucl Med. 2008;49:1593–600. https://doi.org/10.2967/jnumed.108.053660.

    Article  Google Scholar 

  13. Arias F, Chicata V, Garcia-Velloso MJ, Asin G, Uzcanga M, Eito C, et al. Impact of initial FDG PET/CT in the management plan of patients with locally advanced head and neck cancer. Clin Translat Oncol : Off Publ Fed Spanish Oncol Soc National Cancer Instit Mexico. 2015;17:139–44. https://doi.org/10.1007/s12094-014-1204-8.

    Article  CAS  Google Scholar 

  14. Abramyuk A, Appold S, Zophel K, Baumann M, Abolmaali N. Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft [et al]. 2013;189:197–201. https://doi.org/10.1007/s00066-012-0283-0.

    Article  CAS  Google Scholar 

  15. Prestwich RJ, Bhatnagar P, Chowdhury FU, Patel CN, Dyker KE, Coyle C, et al. The impact of (18)F-FDG PET CT prior to Chemoradiotherapy for stage III/IV head and neck Squamous cell carcinoma. ISRN Oncol. 2012;2012:636379. https://doi.org/10.5402/2012/636379.

    PubMed  PubMed Central  Google Scholar 

  16. Paidpally V, Tahari AK, Lam S, Alluri K, Marur S, Koch W, et al. Addition of 18F–FDG PET/CT to Clinical Assessment Predicts Overall Survival in HNSCC: A Retrospective Analysis with Follow-up for 12 Years. J Nucl Med : Off Publ, Soc Nucl Med. 2013; https://doi.org/10.2967/jnumed.113.121285.

  17. Fleming AJ Jr, Smith SP Jr, Paul CM, Hall NC, Daly BT, Agrawal A, et al. Impact of [18F]-2-fluorodeoxyglucose-positron emission tomography/computed tomography on previously untreated head and neck cancer patients. Laryngoscope. 2007;117:1173–9. https://doi.org/10.1097/MLG.0b013e31805d017b.

    Article  PubMed  Google Scholar 

  18. Connell CA, Corry J, Milner AD, Hogg A, Hicks RJ, Rischin D, et al. Clinical impact of, and prognostic stratification by, F-18 FDG PET/CT in head and neck mucosal squamous cell carcinoma. Head Neck. 2007;29:986–95. https://doi.org/10.1002/hed.20629.

    Article  PubMed  Google Scholar 

  19. Zanation AM, Sutton DK, Couch ME, Weissler MC, Shockley WW, Shores CG. Use, accuracy, and implications for patient management of [18F]-2-fluorodeoxyglucose-positron emission/computerized tomography for head and neck tumors. Laryngoscope. 2005;115:1186–90.

    Article  PubMed  Google Scholar 

  20. Ha PK, Hdeib A, Goldenberg D, Jacene H, Patel P, Koch W, et al. The role of positron emission tomography and computed tomography fusion in the management of early-stage and advanced-stage primary head and neck squamous cell carcinoma. Arch Otolaryngol0--Head Neck Surg. 2006;132:12–6. https://doi.org/10.1001/archotol.132.1.12.

    Article  Google Scholar 

  21. Ryu IS, Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, et al. Impact of (18)F-FDG PET/CT staging on management and prognostic stratification in head and neck squamous cell carcinoma: A prospective observational study. Europe J Cancer (Oxford, England : 1990). 2016;63:88–96. https://doi.org/10.1016/j.ejca.2016.05.002.

    Google Scholar 

  22. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg (London, England). 2014;12:1500–24. https://doi.org/10.1016/j.ijsu.2014.07.014.

    Article  Google Scholar 

  23. Rohde M, Nielsen AL, Johansen J, Sorensen JA, Diaz A, Asmussen JT, et al. 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 : Off Publ, Soc Nuclear Med. 2017; https://doi.org/10.2967/jnumed.117.189704.

  24. Greenland P. Comments on 'Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond' by M. J. Pencina, R. B. D'Agostino Sr, R. B. D'Agostino Jr, R. S. Vasan, statistics in medicine (DOI: 10.1002/sim.2929). Stat Med. 2008;27:188–90. https://doi.org/10.1002/sim.2976.

    Article  PubMed  Google Scholar 

  25. Pencina MJ, D'Agostino RB Sr, D'Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157–172; discussion 207-12. https://doi.org/10.1002/sim.2929.

    Article  PubMed  Google Scholar 

  26. Cook NR. Use and misuse of the receiver operating characteristic curve in risk prediction. Circulation. 2007;115:928–35. https://doi.org/10.1161/circulationaha.106.672402.

    Article  PubMed  Google Scholar 

  27. Gordin A, Golz A, Keidar Z, Daitzchman M, Bar-Shalom R, Israel O. The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care. Otolaryngol--Head Neck Surg : Off J Am Acad Otolaryngol-Head Neck Surg. 2007;137:130–7. https://doi.org/10.1016/j.otohns.2007.02.001.

    Article  Google Scholar 

  28. Gerke O, Hermansson R, Hess S, Schifter S, Vach W, Hoilund-Carlsen PF. Cost-effectiveness of PET and PET/computed tomography: a systematic review. PET Clin. 2015;10:105–24. https://doi.org/10.1016/j.cpet.2014.09.008.

    Article  PubMed  Google Scholar 

  29. Gerke O, Hoilund-Carlsen PF, Poulsen MH, Vach W. Interim analyses in diagnostic versus treatment studies: differences and similarities. Am J Nucl Med Mol Imaging. 2012;2:344–52.

    PubMed  PubMed Central  Google Scholar 

  30. Siepe B, Hoilund-Carlsen PF, Gerke O, Weber WA, Motschall E, Vach W. The move from accuracy studies to randomized trials in PET: current status and future directions. J Nucl Med : Off Publ, Soc Nucl Med. 2014;55:1228–34. https://doi.org/10.2967/jnumed.113.127076.

    Article  Google Scholar 

  31. Vach W, Hoilund-Carlsen PF, Gerke O, Weber WA. Generating evidence for clinical benefit of PET/CT in diagnosing cancer patients. J Nucl Med : Off Publ, Soc Nucl Med. 2011;52(Suppl 2):77S–85S. https://doi.org/10.2967/jnumed.110.085704.

    Article  Google Scholar 

  32. Gerke O, Hoilund-Carlsen PF, Vach W. Analyzing paired diagnostic studies by estimating the expected benefit. Biom J. 2015;57:395–409. https://doi.org/10.1002/bimj.201400020.

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was financially supported by the University of Southern Denmark, the Danish Cancer Society, and the Region of Southern Denmark.

Funding

We are grateful for the doctoral research grants given by the University of Southern Denmark, the Danish Cancer Society and the Region of Southern Denmark.

Author information

Authors and Affiliations

  1. Department of ORL - Head & Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark

    Max Rohde, Helle Døssing, Kristine Bjørndal & Christian Godballe

  2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Max Rohde, Jens A. Sørensen, Poul Flemming Høilund-Carlsen & Christian Godballe

  3. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Anne L. Nielsen, Oke Gerke, Anders Thomassen & Poul Flemming Høilund-Carlsen

  4. Department of Oncology, Odense University Hospital, Odense, Denmark

    Jørgen Johansen & Niels Gyldenkerne

  5. Department of Plastic Surgery, Odense University Hospital, Odense, Denmark

    Jens A. Sørensen

  6. Department of Radiology, Odense University Hospital, Odense, Denmark

    Anabel Diaz & Jon T. Asmussen

  7. Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark

    Oke Gerke

Authors
  1. Max Rohde
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Contributions

Conception and design: Max Rohde, Poul Flemming Høilund-Carlsen, Christian Godballe.

Administrative support: Anne L. Nielsen.

Provision of study materials or patients: Max Rohde, Christian Godballe.

Collection and assembly of data: Max Rohde, Jørgen Johansen, Jens A. Sørensen Anne L. Nielsen, Jon T. Asmussen, Anabel Diaz, Anders Thomassen, Niels Gyldenkerne, Helle Døssing, Kristine Bjrøndal, Christian Godballe.

Data analysis and interpretation: Max Rohde, Jørgen Johansen, Jens A. Sørensen, Oke Gerke, Poul Flemming Høilund-Carlsen, Christian Godballe.

Manuscript writing: All authors.

Final approval of manuscript: All authors.

Corresponding author

Correspondence to Max Rohde.

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We declare no conflicts of interest.

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Rohde, M., Nielsen, A.L., Johansen, J. et al. Up-front PET/CT changes treatment intent in patients with head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging 45, 613–621 (2018). https://doi.org/10.1007/s00259-017-3873-3

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