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FDG-PET/CT improves detection of residual disease and reduces the need for examination under anaesthesia in oropharyngeal cancer patients treated with (chemo-)radiation

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Abstract

Purpose

Early detection of residual disease (RD) after (chemo)radiation for oropharyngeal (OPC) is crucial. Surveillance of neck nodes with FDG-PET/CT has been studied extensively, whereas its value for local RD remains less clear. We aim to evaluate the diagnostic value of post-treatment FDG-PET/CT in detecting local RD and the outcome of patients with local RD.

Methods

A cohort (n = 352) of consecutively treated OPC patients at our institute between 2010 and 2017 was evaluated. Patients that underwent FDG-PET/CT at 3 months post-treatment (n = 94) were classified as having complete (CMR) or partial metabolic response (PMR). PMR was defined as visually detectable metabolic activity above the background of surrounding normal tissues. Primary endpoint was diagnostic accuracy in detecting local RD.

Results

Local RD was seen in 19/352 patients (5%), all of them were HPV negative. The FDG-PET/CT had a sensitivity of 100% (8/8), specificity 85% (73/86), PPV 38% (8/21), NPV 100% (73/73), and accuracy 86%. Patients with local RD had significantly worse OS at 2 years, compared to those without (10 versus 88%, P < 0.001). In multivariable analysis, local RD remained a significant predictive factor for death with a hazard ratio of 11.9 (95% CI 5.8–24.3). The number of patients that underwent PET/CT increased over time (P < 0.001), whereas the number of patients that underwent EUA declined (P = 0.072).

Conclusion

FDG-PET/CT has excellent performance for the detection of RD, with the sensitivity and negative predictive value approaching 100%. Due to these excellent results is examination under anaesthesia today in the vast majority of the PET-negative cases not necessary anymore.

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Authors and Affiliations

  1. Department of Radiation Oncology, Antoni van Leeuwenhoek – Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Mischa de Ridder, Zeno A. R. Gouw, Arash Navran, Olga Hamming-Vrieze, Wouter V. Vogel & A. Al-Mamgani

  2. Department of Radiation Oncology, Verbeeten Instituut, Tilburg, The Netherlands

    Mischa de Ridder

  3. Department of Radiology, Antoni van Leeuwenhoek/Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands

    Bas Jasperse

  4. Department of Head and Neck Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands

    Michiel W. M. van den Brekel

  5. Amsterdam UMC, Department of Maxillo-facial Surgery, University of Amsterdam, Amsterdam, The Netherlands

    Michiel W. M. van den Brekel

  6. Department of Nuclear Medicine, Antoni van Leeuwenhoek/Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands

    Wouter V. Vogel

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  1. Mischa de Ridder
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  2. Zeno A. R. Gouw
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  8. A. Al-Mamgani
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Correspondence to A. Al-Mamgani.

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de Ridder, M., Gouw, Z.A.R., Navran, A. et al. FDG-PET/CT improves detection of residual disease and reduces the need for examination under anaesthesia in oropharyngeal cancer patients treated with (chemo-)radiation. Eur Arch Otorhinolaryngol 276, 1447–1455 (2019). https://doi.org/10.1007/s00405-019-05340-9

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  • DOI: https://doi.org/10.1007/s00405-019-05340-9

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