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Benefit of [18F] FDG PET/CT in the diagnosis and salvage treatment of recurrent nasopharyngeal carcinoma

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

Abstract

Purpose

To compare PET/CT, MRI and ultrasonography in detecting recurrence of nasopharyngeal carcinoma and identify their benefit in staging, contouring and overall survival (OS).

Methods

Cohort A included 1453 patients with or without histopathology-confirmed local recurrence, while cohort B consisted of 316 patients with 606 histopathology-confirmed lymph nodes to compare the sensitivities and specificities of PET/CT, MRI and ultrasonography using McNemar test. Cohorts C and D consisted of 273 patients from cohort A and 267 patients from cohort B, respectively, to compare the distribution of PET/CT-based and MRI-based rT-stage and rN-stage and the accuracy of rN-stage using McNemar test. Cohort E included 30 random patients from cohort A to evaluate the changes in contouring with or without PET/CT by related-samples T test or Wilcoxon rank test. The OS of 61 rT3-4N0M0 patients staged by PET/CT plus MRI (cohort F) and 67 MRI-staged rT3-4N0M0 patients (cohort G) who underwent similar salvage treatment were compared by log-rank test and Cox regression.

Results

PET/CT had similar specificity to MRI but higher sensitivity (93.9% vs. 79.3%, P < 0.001) in detecting local recurrence. PET/CT, MRI and ultrasonography had comparable specificities, but PET/CT had greater sensitivity than MRI (90.9% vs. 67.6%, P < 0.001) and similar sensitivity to ultrasonography in diagnosing lymph nodes. According to PET/CT, more patients were staged rT3-4 (82.8% vs. 68.1%, P < 0.001) or rN + (89.9% vs. 69.3%, P < 0.001), and the rN-stage was more accurate (90.6% vs. 73.8%, P < 0.001). Accordingly, the contours of local recurrence were more precise (median Dice similarity coefficient 0.41 vs. 0.62, P < 0.001) when aided by PET/CT plus MRI. Patients staged by PET/CT plus MRI had a higher 3-year OS than patients staged by MRI alone (85.5% vs. 60.4%, P = 0.006; adjusted HR = 0.34, P = 0.005).

Conclusion

PET/CT more accurately detected and staged recurrence of nasopharyngeal carcinoma and accordingly complemented MRI, providing benefit in contouring and OS.

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Data availability

The dataset generated during and/or analysed during the current study is available from the corresponding author on reasonable request.

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Funding

This work was supported by the Sun Yat-sen University Clinical Research 5010 Program (2015020).

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China

    Pu-Yun OuYang, Zhi-Qiao Liu, Wen-Yan Yao, Sen-Kui Xu, Qing-He Peng, Su-Ming Xiao, Bao-Yu Zhang, Chun-Yan Chen & Fang-Yun Xie

  2. Department of Ultrasound, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, China

    Qing-Guang Lin & Zhi-Xin Guo

  3. Department of Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, China

    Yun He & Chuan-Miao Xie

  4. CVTE Research, Guangzhou, Guangdong, China

    Jiajian Li & Anwei Li

  5. Department of Radiation Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, Shandong, China

    Shan-Shan Yang

  6. Department of Nuclear Medicine, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, China

    Wei Fan & Xu Zhang

  7. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China

    Yi-Shan Wu

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  1. Pu-Yun OuYang
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Corresponding author

Correspondence to Fang-Yun Xie.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Sun Yat-sen University Cancer Center (SYSUCC) (No. B2020-222–01 and No. B2020-334–01).

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Informed consent was obtained from all individual participants included in the prospective study but was waved in the retrospective study.

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The authors declare no competing interests.

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Pu-Yun OuYang, Zhi-Qiao Liu, Qing-Guang Lin, and Yun He are joint first authors.

Yi-Shan Wu, Xu Zhang, Chun-Yan Chen, and Fang-Yun Xie are joint senior authors.

This article is part of the Topical Collection on Oncology - Head and Neck

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OuYang, PY., Liu, ZQ., Lin, QG. et al. Benefit of [18F] FDG PET/CT in the diagnosis and salvage treatment of recurrent nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging 50, 881–891 (2023). https://doi.org/10.1007/s00259-022-06020-3

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