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18F-FDG PET/CT to assess response and guide risk-stratified follow-up after chemoradiotherapy for oropharyngeal squamous cell carcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the use of 18F-FDG PET/CT as the principal investigation to assess tumour response, to determine the need for further surgery and to guide follow-up following radical chemoradiotherapy for stage III/IV oropharyngeal squamous cell carcinoma (OPSCC).

Methods

A retrospective analysis was undertaken in 146 patients treated at our centre with radical chemoradiotherapy for OPSCC and who had a PET/CT scan to assess response. According to the PET/CT findings, patients were divided into four groups and recommendations: (1) complete metabolic response (enter clinical follow-up); (2) low-level uptake only (follow-up PET/CT scan in 12 weeks); (3) residual uptake suspicious for residual disease (further investigation with or without neck dissection); and (4) new diagnosis of distant metastatic disease (palliative treatment options).

Results

The initial PET/CT scan was performed at a median of 12.4 weeks (range 4.3 – 21.7 weeks) following treatment. Overall sensitivity and specificity rates were 92.0 % (74.0 – 99.0 %) and 85 % (77.5 – 90.9 %). Of the 146 patients, 90 (62 %) had a complete response and had estimated 3-year overall and disease-free survival rates of 91.9 % (85.6 – 98.2 %) and 85.6 % (78.0 – 93.2 %), respectively, 17 (12 %) had residual low-level uptake only (with two having confirmed residual disease on subsequent PET/CT, both surgically salvaged), 30 (21 %) had suspicious residual uptake (12 proceeded to neck dissection; true positive rate at surgery 33 %). HPV-positive patients with reassuring PET/CT findings had an estimated 3-year progression-free survival rate of 91.7 % (85.2 – 98.2 %), compared with 66.2 % (41.5 – 90.9 %) of HPV-negative patients.

Conclusion

A strategy of using PET/CT results alongside clinical examination to help select patients for salvage surgery appears successful. Despite a complete response on the 12-week PET/CT scan, HPV-negative patients have a significant risk of disease relapse in the following 2 years and further studies to assess whether surveillance imaging in this group could improve outcomes are warranted.

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Author information

Authors and Affiliations

  1. Department of Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Thomas Bird, Mary Lei & Teresa Guerrero Urbano

  2. PET Imaging Centre at St Thomas’ Hospital, King’s College, London, UK

    Sally Barrington

  3. Head and Neck Pathology Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Selvam Thavaraj

  4. Department of Head & Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Jean-Pierre Jeannon, Andrew Lyons, Richard Oakley & Ricard Simo

Authors
  1. Thomas Bird
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Correspondence to Thomas Bird.

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No external funding was received.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was not required (retrospective study).

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Bird, T., Barrington, S., Thavaraj, S. et al. 18F-FDG PET/CT to assess response and guide risk-stratified follow-up after chemoradiotherapy for oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 43, 1239–1247 (2016). https://doi.org/10.1007/s00259-015-3290-4

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