Temporal patterns of head and neck squamous cell carcinoma recurrence with positron-emission tomography/computed tomography monitoring

Authors

  • Daniel M. Beswick MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh
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  • William E. Gooding MS,

    1. University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, U.S.A.
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  • Jonas T. Johnson MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh
    • Suite 500, Eye and Ear Institute, 200 Lothrop St., Pittsburgh, PA 15213
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  • Barton F. Branstetter IV MD

    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh
    2. Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

  • Presented as a poster presentation at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 27–29, 2011.

Abstract

Objectives/Hypothesis:

To estimate the distribution of head and neck squamous cell carcinoma (HNSCC) recurrence after definitive chemoradiation therapy (CRT) among patients who underwent 18F-fluorodeoxyglucose positron-emission tomography and computed tomography (PET/CT) surveillance.

Study Design:

Retrospective review.

Methods:

HNSCC patients who underwent definitive CRT from 2001 to 2008 were evaluated for recurrence with serial PET/CT. Patients were excluded if they were previously treated for recurrent disease, were treated with surgery as the primary therapeutic modality, or had inadequate clinical follow-up. Recurrence was defined by histopathologic evidence of tumor.

Results:

Three hundred eighty-eight patients were studied. Patients in whom recurrence was not detected were followed clinically and radiographically for a median of 27 months. Tumor recurrence was detected in 110 patients. For 37 patients, recurrence was heralded by clinical signs. Among the 73 asymptomatic patients who had a confirmed recurrence, disease was detected by PET/CT between 2 and 43 months, median of 6 months. Forty-five percent of observed asymptomatic recurrences were detected during the first 6 months of surveillance (95% confidence interval [CI], 34%-57%), 79% within the first 12 months (95% CI, 68%-88%), 95% within the first 24 months (95% CI, 87%-98%), and 100% within the first 48 months (95% CI, 95%-100%).

Conclusions:

Among HNSCC patients followed with PET/CT surveillance, 95% of observed asymptomatic recurrences were detected within 24 months after completing CRT. For patients without clinical signs of recurrence, routine PET/CT surveillance beyond the first 24 months may be of limited value and may not be cost effective. Laryngoscope, 2012

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