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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    A. Nøhr, S. B. Gram, B. Charabi, J. F. Tvedskov, I. Wessel, C. von Buchwald & Jacob H. Rasmussen

  2. Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    J. Friborg & K. Håkansson

  3. Department of Clinical Physiology, Nuclear Medicine and PET, PET and Cyclotron Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    B. M. Fischer

  4. The Pet Centre, School of Biomedical Engineering and Imaging Sciences, KCL St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    B. M. Fischer

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  1. A. Nøhr
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Correspondence to Jacob H. Rasmussen.

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

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

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Nøhr, A., Gram, S.B., Charabi, B. et al. PET/CT prior to salvage surgery in recurrent head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 276, 2895–2902 (2019). https://doi.org/10.1007/s00405-019-05550-1

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