Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence

Authors

  • Allen S. Ho MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • Gabriel J. Tsao MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • Frank W. Chen BA,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • Tianjie Shen MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • Michael J. Kaplan MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • A. Dimitrios Colevas MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
    2. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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  • Nancy J. Fischbein MD,

    1. Department of Radiology, Stanford University School of Medicine, Palo Alto, California
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  • Andrew Quon MD,

    1. Division of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, Palo Alto, California
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  • Quynh-Thu Le MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
    2. Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
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  • Harlan A. Pinto MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
    2. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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  • Willard E. Fee Jr MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • John B. Sunwoo MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • Davud Sirjani MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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  • Wendy Hara MD,

    1. Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
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  • Mike Yao MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
    • New York Medical College, Department of Otolaryngology, 1055 Saw Mill River Rd, Ardsley, NY 10502
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    • Fax: (914) 693-5994


Abstract

BACKGROUND:

In head and neck cancer (HNC), 3-month post-treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of post-treatment PET/CT surveillance on outcomes is assessed at 12 and 24 months.

METHODS:

A 10-year retrospective analysis of HNC patients was carried out with long-term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3-month scans, 175 had 3- and 12-month scans, and 77 had 3-, 12-, and 24-month scans.

RESULTS:

PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT-detected and clinically detected recurrences, with similar 3-year disease-free survival (41% vs 46%, P = .91) and 3-year overall survival (60% vs 54%, P = .70) rates. Compared with 3-month PET/CT, 12-month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive.

CONCLUSIONS:

HNC patients with negative 3-month imaging appear to derive limited benefit from subsequent PET/CT surveillance. No survival differences were observed between PET/CT-detected and clinically detected recurrences, although larger prospective studies are needed for further investigation. Cancer 2013. © 2012 American Cancer Society.

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