Nuclear medicine

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

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. Head and neck cancers represent about 3–4% of all new cancer cases worldwide and more than 90% of these head and neck cancers are squamous cell carcinomas (HNSCC).

Use of 18F-FDG PET/CT scans

The treatment of HNSCC is multidisciplinary ;and consists of surgery and/or radiotherapy with or without chemotherapy depending on disease stage and anatomical location. Recurrence is experience by about 40% of the patients,causing severe morbidity and mortality. The prognosis after recurrence is poor and salvage surgery is usually the only option for curative treatment. It is crucial to select the right patients for salvage treatment to avoid unnecessary treatment morbidity; especially in cases where salvage proves to be unobtainabl.

Functional imaging with [18F]fuorodeoxyglucose (FDG) positron emission tomography combine with compute tomography (PET/CT) is increasingly used in the management of HNSCC both in the pre-, per-, and post-treatment setting. In the pre treatment setting;  has, in some studies; been shows to improve staging and the diagnostic workup for patients with neck metastasis and unknown primary tumor as well as the detection of distant metastases.

Post-treatment setting

In the per-treatment setting, the use of FDG PET/CT ;reduces the variability in target delineation for radiotherapy and can be use in more advance experimental radiotherapy planning such as dose painting. In the post-treatment setting; surveillance with PET/CT is non-inferior to plan neck dissections after primary treatment with radiotherapy.

The use of PET/CT may potentially help patients avoid unnecessary salvage surgery in case of distant metastases or excessive disease; making it an important factor when deciding treatment modalities.  However; studies that have investigate the use of PET/CT in recurrent HNSCC are limit to specifc parts of the workup and treatment process.

The impact of PET/CT

The purposes of the current study are twofold (1) to investigate the use of PET/CT ;in patients with recurrent HNSCC; prior to salvage surgery by assessing how often distant metastases are reveal and (2) to investigate the survival after recurrence in patients treated with salvage surgery and patients not treated with salvage surgery PET/CT; is increasingly used in the management of HNSCC and implemented in diferent guidelines.

In the current study; we investigated the impact of PET/CT to detect distant metastasis in patients with recurrent HNSCC, prior to salvage surgery. All scans referred from the Department of Otorhinolaryngology; Head and Neck Surgery and Audiology between 2012 and 2014 were initially reviewed and only those eligible with recurrent HNSCC were included for further analysis