The Added Value of [68Ga]Ga-DOTA-FAPI-04 PET/CT in Patients with Head and Neck Cancer of Unknown Primary with [18F]FDG Negative Findings

Abstract Purpose [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) plays an important role in location of primary tumor for patients with head and neck cancer of unknown primary (HNCUP). But sometimes, [18F]FDG PET/CT still cannot find the primary malignancy. As 68Ga-radiolabeled fibroblast activation protein inhibitor (FAPI) PET/CT has promising results in detecting different tumor entities, our study aimed to evaluate the performance of [68Ga]Ga-DOTA-FAPI-04 PET/CT for detecting the primary tumor in HNCUP patients with negative [18F]FDG findings.Methods A total of eighteen patients (16 males and 2 females; median age, 55 years; range, 24-72 years) with negative [18F]FDG findings were eligible in this study. All patients underwent [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 PET/CT within one week. Biopsy and histopathological examinations were done in the sites with positive [68Ga]Ga-DOTA-FAPI-04 PET/CT findings. Results [68Ga]Ga-DOTA-FAPI-04 PET/CT detected the primary tumor in 7 of 18 patients (38.89%). The primary tumors sites were in nasopharynx (1/7), palatine tonsil (2/7), submandibular gland (2/7), and hypopharynx (2/7). The primary tumors showed mild to intensive uptake of FAPI (mean SUVmax, 8.79; range, 2.60-16.50) and excellent tumor-to-contralateral normal tissue ratio (mean SUVmax ratio, 4.50; range, 2.17-8.21). In lesion-based analysis, a total of 65 lymph nodes and 17 bone metastatic lesions were identified. The mean SUVmax of lymph node metastases were 9.05 ± 5.29 for FDG and 9.08 ± 4.69 for FAPI (p = 0.975); as for bone metastases, the mean SUVmax were 8.11 ± 3.00 for FDG and 6.96 ± 5.87 for FAPI, respectively (p = 0.478). The mean tumor-to-background ratio (TBR) values of lymph node and bone metastases were 10.65 ± 6.59 vs. 12.80 ± 8.11 (p = 0.100) and 9.08 ± 3.35 vs. 9.14 ± 8.40 (p = 0.976), respectively.Conclusion We present first evidence of diagnostic role of [68Ga]Ga-DOTA-FAPI-04 PET/CT in HNCUP, and our study demonstrated that [68Ga]Ga-DOTA-FAPI-04 PET/CT had the potential to improve the detection rate of primary tumor in HNCUP patients with negative FDG findings. Moreover, [68Ga]Ga-DOTA-FAPI-04 had similar performance in assessing metastases with [18F]FDG.

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PET/CT Evaluation of Head and Neck Cancer of Unknown Primary

Seminars in Ultrasound CT and MRI ◽

10.1053/j.sult.2019.07.005 ◽

2019 ◽

Vol 40 (5) ◽

pp. 414-423 ◽

Cited By ~ 1

Author(s):

Megan Albertson ◽

Srinivasa Chandra ◽

Zafar Sayed ◽

Craig Johnson

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Cancer Of Unknown Primary ◽

Unknown Primary ◽

Pet Ct ◽

Ct Evaluation

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The Added Value of 68Ga-FAPI-04 PET/CT in Patients with Head and Neck Cancer of Unknown Primary with 18F-FDG Negative Findings

Journal of Nuclear Medicine ◽

10.2967/jnumed.121.262790 ◽

2021 ◽

pp. jnumed.121.262790

Author(s):

Bingxin Gu ◽

Xiaoping Xu ◽

Ji Zhang ◽

Xiaomin Ou ◽

Zuguang Xia ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Cancer Of Unknown Primary ◽

Added Value ◽

Unknown Primary ◽

Pet Ct ◽

Negative Findings ◽

18F Fdg

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Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors

Otolaryngology ◽

10.1177/0194599819900794 ◽

2020 ◽

Vol 162 (3) ◽

pp. 313-318 ◽

Cited By ~ 1

Author(s):

Jasmijn M. Herruer ◽

S. Mark Taylor ◽

Colin A. MacKay ◽

Kishan M. Ubayasiri ◽

Deanna Lammers ◽

...

Keyword(s):

Adjuvant Therapy ◽

Head And Neck ◽

Adjuvant Treatment ◽

Primary Tumor ◽

Frozen Section ◽

Unknown Primary ◽

Frozen Sections ◽

Margin Assessment ◽

Primary Tumors ◽

Pet Ct

Objective Surgical management of the unknown primary head and neck squamous cell carcinoma (UP HNSCC) remains controversial due to challenging clinical diagnosis. This study compares positron emission tomography–computed tomography (PET-CT) findings with intraoperative identification of primary tumors and compares intraoperative frozen-section margins to final histopathology. In addition, adjuvant therapy indications are provided. Study Design Prospective cohort study. Setting Academic university hospital. Subjects and Methods Sixty-one patients with UP HNSCC were included. Patients received PET-CT, followed by oropharyngeal transoral laser microsurgery (TLM). Margins were assessed intraoperatively using frozen sections and afterward by final histopathology. Adjuvant treatment was based on final histopathology. Results The sensitivity of localizing the primary tumor with PET-CT was 50.9% with a specificity of 82.5%. The primary tumor was found intraoperatively on frozen sections in 82% (n = 50) of patients. Five more tumors were identified on final histopathology, leading to a total of 90% (n = 55). Of the 50 intraoperatively found tumors, 98% (n = 49) had negative margins on frozen sections, and 90% (n = 45) were truly negative on final histopathology. Eighteen patients (29.5%) avoided adjuvant treatment. Conclusion PET-CT localized the primary tumor in fewer than half the cases. This protocol identified 90% of primary tumors. Intraoperative frozen-section margin assessment has shown potential with a specificity of 92% compared to final histopathology. As a result, adjuvant therapy was avoided in almost one-third of our patients.

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Change of three-dimensional DW-MRI for primary tumor and cervical lymph nodes in head and neck cancer during radiotherapy: A phase II prospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17522 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17522-e17522

Author(s):

Mei Feng ◽

Jinyi Lang ◽

Fei Wu ◽

Xiaochun Chen ◽

Peng Xu ◽

...

Keyword(s):

Head And Neck Cancer ◽

Lymph Node ◽

Head And Neck ◽

Neck Cancer ◽

Primary Tumor ◽

Dynamic Change ◽

Volume Reduction ◽

Adc Value ◽

The Mean ◽

Delivered Dose

e17522 Background: DW-MRI become more important, recent study find it help to discriminate metastatic lymph node and distinguish recurrent tumor. However, we still poorly understand the dynamic change of it during treatment, especially for 3D-apparent diffusion coefficient (ADC). It is urgent to study the dynamic change of 3D-ADC for head and neck cancer during radiotherapy, and to investigate the correlation between the ADC change, radiation dose and volume reduction. Methods: 60 head and neck cancer patients treated with image guided IMRT were enrolled. DW-MRI were performed on 3.0T MRI (b = 0, 500, 800 s/mm2) at pre-radiation, the 15th, the 25thand post-radiation. Region of interest was primary tumor (GTV-T) and cervical lymph node (GTV-N). The volumes and the maximum, mean and minimum of 3D-ADC value were automatically measured by MIM software. Pearson analysis was used to assess the correlation between 3D-ADC values, delivered radiation dose and tumor volume reduction. Results: All the patients exhibited the mean 3D-ADC increase in GTV-T (0.64±0.24 x10-3 mm2/s) and GTV-N (0.35±0.09 x10-3 mm2/s), with the mean increased ratios of 0.50±0.20 and 0.44±0.08 between pre- and post-radiation. However, the changes of the maximum and minimum 3D-ADC values for GTV-T and GTV-N had no correlation with delivered dose and volume reduction. The maximum, mean and minimum 3D-ADC changes in spinal cord were almost invisible (≤ 0.04 x10-3 mm2/s). The increased mean ADC had a strong positive correlation with the increased radiation delivered dose for GTV-T and GTV-N respectively (r = 0.977, p= 0.023; r = 0.974 , p= 0.026), and a significantly negative correlation with the volume reduction (r = -0.989, p= 0.011; r = -0.969 , p = 0.031) . Conclusions: The mean 3D-ADC value of primary tumor and cervical lymph node can be increased greatly for head and neck cancer during radiotherapy. It had a strong negative correlation with the volume reduction, and a positive correlation with the increased delivered dose. Dynamic 3D-ADC changes during radiotherapy might be an early indicator to assess the treatment response and helps to make treatment strategy for head and neck cancer.

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Swedish National Multicenter Study on Head and Neck Cancer of Unknown Primary: Prognostic Factors and Impact of Treatment on Survival

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1712106 ◽

2020 ◽

Author(s):

Lars Axelsson ◽

Erik Holmberg ◽

Jan Nyman ◽

Anders Högmo ◽

Helena Sjödin ◽

...

Keyword(s):

Head And Neck Cancer ◽

Prognostic Factors ◽

Head And Neck ◽

Neck Dissection ◽

Neck Cancer ◽

Multicenter Study ◽

Performance Status ◽

Cancer Of Unknown Primary ◽

Unknown Primary ◽

N Stage

Abstract Introduction Head and neck cancer of unknown primary (HNCUP) is a rare condition whose prognostic factors that are significant for survival vary between studies. No randomized treatment study has been performed thus far, and the optimal treatment is not established. Objective The present study aimed to explore various prognostic factors and compare the two main treatments for HNCUP: neck dissection and (chemo) radiation vs primary (chemo) radiation. Methods A national multicenter study was performed with data from the Swedish Head and Neck Cancer Register (SweHNCR) and from the patients' medical records from 2008 to 2012. Results Two-hundred and sixty HNCUP patients were included. The tumors were HPV-positive in 80%. The overall 5-year survival rate of patients treated with curative intent was 71%. Age (p < 0.001), performance status (p= 0.036), and N stage (p= 0.046) were significant factors for overall survival according to the multivariable analysis. Treatment with neck dissection and (chemo) radiation (122 patients) gave an overall 5-year survival of 73%, and treatment with primary (chemo) radiation (87 patients) gave an overall 5-year survival of 71%, with no significant difference in overall or disease-free survival between the 2 groups. Conclusions Age, performance status, and N stage were significant prognostic factors. Treatment with neck dissection and (chemo) radiation and primary (chemo) radiation gave similar survival outcomes. A randomized treatment study that includes quality of life is needed to establish the optimal treatment.

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