Quality Assessment in FDG-PET/CT Imaging of Head-and-Neck Cancer: One Home Run Is Better Than Two Doubles

Purpose [18F]Fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) imaging may improve assessment of radiation response in patients with head and neck cancer, but it is not yet known for which patients this is most useful. We conducted a prospective trial to identify patient populations likely to benefit from the addition of functional imaging to the assessment of radiotherapy response. Patients and Methods Ninety-eight patients with locally advanced cancer of the oropharynx, larynx, or hypopharynx were prospectively enrolled and treated with primary radiotherapy, with or without chemotherapy. Patients underwent FDG-PET/CT and contrast-enhanced CT imaging 8 weeks after completion of treatment. Functional and anatomic imaging response was correlated with clinical and pathologic response. Imaging accuracy was then compared between imaging modalities. Results Although postradiation maximum standard uptake values were significantly higher in nonresponders compared with responders, the positive and negative predictive values of FDG-PET/CT scanning were similar to those for CT alone in the unselected study population. Subset analyses revealed that FDG-PET/CT outperformed CT alone in response assessment for patients at high risk for treatment failure (those with human papillomavirus [HPV] –negative disease, nonoropharyngeal primaries, or history of tobacco use). No benefit to FDG-PET/CT was seen for low-risk patients lacking these features. Conclusion These data do not support the broad application of FDG-PET/CT for radiation response assessment in unselected head and neck cancer patients. However, FDG-PET/CT may be the imaging modality of choice for patients with highest risk disease, particularly those with HPV-negative tumors. Optimal timing of FDG-PET/CT imaging after radiotherapy merits further investigation.

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Incidental Findings on FDG PET/CT in Head and Neck Cancer

Otolaryngology ◽

10.1177/0194599817742579 ◽

2017 ◽

Vol 158 (3) ◽

pp. 484-488 ◽

Cited By ~ 9

Author(s):

Christopher J. Britt ◽

Austin M. Maas ◽

Tabassum A. Kennedy ◽

Gregory K. Hartig

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Fdg Pet ◽

Incidental Findings ◽

Ct Imaging ◽

Additional Patient ◽

Pet Ct ◽

Fdg Pet Ct

Objective 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) imaging is common in head and neck cancer and often identifies incidental findings that necessitate additional patient evaluations. Our goal was to assess the frequency and nature of these incidental imaging findings on FDG-PET/CT. Study Design Retrospective cohort study. Setting Tertiary medical center. Subjects and Methods All patients with head and neck cancer who had undergone FDG-PET/CT imaging between January 2014 and June 2015 at our institution were evaluated for incidental findings. Results A total of 293 patients met criteria; more than one-third (n = 103) had at least 1 finding unrelated to their head and neck cancer, for a total of 134 incidental findings. Incidental findings within the head and neck (33.5% of all) excluding the thyroid were most common: 35% incidental findings were concerning for malignancy; of these, 25.5% were malignant with further workup. Recommendations were given by the head and neck radiologist on 72 (53.7%) findings: 74.5% of potentially malignant findings and 42.5% of benign findings had recommendations for follow-up. Significantly more patients with findings described as malignant were given recommendations for follow-up ( P = .0004). Conclusion Incidental findings on FDG-PET/CT are present in more than one-third of patients with head and neck cancer. More than one-third of incidental findings were concerning for malignancy. This study illustrates how the incidental findings discovered on FDG PET/CT frequently necessitate additional evaluations unrelated to the index head and neck cancer. The impact of these additional assessments on the cost and quality of health care warrants future evaluation.

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Combined 18F-FDG-PET/CT Imaging in Radiotherapy Target Delineation for Head-and-Neck Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2008.04.059 ◽

2009 ◽

Vol 73 (3) ◽

pp. 759-763 ◽

Cited By ~ 62

Author(s):

Alessandra Guido ◽

Lorenzo Fuccio ◽

Barbara Rombi ◽

Paolo Castellucci ◽

Agnese Cecconi ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Fdg Pet ◽

Ct Imaging ◽

Target Delineation ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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FDG-PET/CT Radiomics Models for The Early Prediction of Loco-regional Recurrence in Head and Neck Cancer

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666200712181135 ◽

2020 ◽

Vol 16 ◽

Author(s):

Hu Cong ◽

Wang Peng ◽

Zhou Tian ◽

Martin Vallières ◽

Xu Chuanpei ◽

...

Keyword(s):

Head And Neck Cancer ◽

Local Recurrence ◽

Head And Neck ◽

Neck Cancer ◽

Fdg Pet ◽

Training Set ◽

Model Based ◽

Pet Ct ◽

Fdg Pet Ct ◽

Better Than

: Purpose Both CT and PET radiomics is considered as a potential prognostic biomarker in head and neck cancer. This study investigate the value of fused pre-treatment functional imaging (18F-FDG PET/CT) radiomics for modeling of local recurrence of head and neck cancers. Material and Methods: Firstly, 298 patients is divided into a training set (n = 192) and verification set (n = 106). Secondly, PETs and CTs are fused based on wavelet transform. Thirdly, radiomics features are extracted from the 3D tumor area from PETCT fusion. The training set is used to select the features reduction and predict local recurrence, and the random forest prediction models combining radiomics and clinical variables are constructed. Finally, the ROC curve and K-M analysis are used to evaluate the prediction efficiency of the model on the validation set. Results: Two PET / CT fusion radiomics features and three clinic parameters are extracted to construct the radiomics model. AUC value in the verification set 0.70 is better than no fused sets 0.69. The accuracy of 0.66 is not the highest value (0.67). Either consistency index CI 0.70 (from 0.67 to 0.70) or the p-value 0.025 (from 0.03 to 0.025) get the best result in all four models. Conclusion: The radiomics model based on the fusion of PETCT is better than the model based on PET or CT alone in predicting local recurrence, the inclusion of clinical parameters may result in more accurate predictions, which has certain guiding significance for the development of personalized precise treatment scheme.

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