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18F-FDG versus 11C-choline PET/CT for the imaging of advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy: the time period during which PET/CT can reliably detect non-recurrence

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Abstract

Purpose

The purpose of this prospective study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) and 11C-choline positron emission tomography (PET)/computed tomography (CT) for detecting recurrences of advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy. Additionally, we surveyed the time period during which an effective negative predictive value could be maintained after the first follow-up PET/CT examination and estimated the optimal timing of a second PET/CT examination for detecting late recurrences.

Methods

Fifty-three subjects (36 men and 17 women; mean age: 59.4 ± 11.5 years) with advanced head and neck squamous cell carcinoma were recruited. Post-treatment 18F-FDG PET/CT and 11C-choline examinations were performed in all patients between 8 and 12 weeks after combined intra-arterial chemotherapy and radiotherapy. The PET/CT images were evaluated using a patient-based analysis and a lesion-based analysis. All of the patients were prospectively followed for at least 9 months after the post-treatment PET/CT examination, with surveillance using conventional images (including CT and/or MRI) and a physical examination performed every 3 months.

Results

Recurrences, as determined using the patient-based analysis, were eventually confirmed in 18, 6 and 5 patients at 3, 4–6 and 7–9 months after the post-treatment PET/CT examination, respectively. The sensitivity and specificity of the 18F-FDG PET/CT and the 11C-choline PET/CT examinations to predict recurrence within 3 months were higher (FDG: 89 and 91%; choline: 83 and 80%, respectively) than for recurrence detection 6 months (FDG: 67 and 90%; choline: 62 and 76%, respectively) and 9 months later (FDG: 59 and 92%; choline: 55 and 75%, respectively). The lesion-based analysis showed that the maximum standardized uptake value of 18F-FDG and 11C-choline in the recurrent lesions were correlated with each other, compared with their relation in scar tissues (R 2 = 0.492 and 0.197, respectively).

Conclusion

11C-choline was not superior to 18F-FDG for the detection of recurrent head and neck cancer. Both modalities had difficulty identifying recurrences at 4–9 months after the post-treatment PET/CT examination. In patients with advanced head and neck cancer who have received combined therapy, a second post-treatment PET/CT examination to check for late recurrences should be performed within 4–6 months after the first post-treatment PET/CT examination.

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Acknowledgements

The authors gratefully thank Mr. Takuya Mitsumoto from the International Medical Center of Japan for his skillful technical assistance, Prof. Katayama Shigehiro from the Department of Endocrinology, Saitama Medical Center University, and Antonia Cavic for correcting the manuscript. This work was supported by a Grant for International Health Research (21A126) from the Ministry of Health, Labor and Welfare.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka city, Saitama prefecture, Japan

    Kimiteru Ito & Hiroshi Matsuda

  2. Head and Neck Surgery, Tochigi Cancer Center, Tochigi, Japan

    Jyunkichi Yokoyama

  3. Department of Radiology, International Medical Center of Japan, Tokyo, Japan

    Kazuo Kubota & Miyako Morooka

  4. Information Technology Center, Saitama Medical University, Saitama, Japan

    Michio Shiibashi

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  1. Kimiteru Ito
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  2. Jyunkichi Yokoyama
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Correspondence to Kimiteru Ito.

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Ito, K., Yokoyama, J., Kubota, K. et al. 18F-FDG versus 11C-choline PET/CT for the imaging of advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy: the time period during which PET/CT can reliably detect non-recurrence. Eur J Nucl Med Mol Imaging 37, 1318–1327 (2010). https://doi.org/10.1007/s00259-010-1400-x

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