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Surveillance for Recurrent Head and Neck Cancer Using Positron Emission Tomography

From the Departments of Nuclear Medicine, Otolaryngology, Head and Neck Surgery, Hematology/Oncology, Radiation Oncology, Pathology, and Radiology, St Louis University; and Department of Health Administration, Washington University, St Louis, MO.

Address reprint requests to Val J. Lowe, MD, PET Imaging, Section of Nuclear Medicine, Charlton 1N-215, Mayo Clinic, Rochester, MN 55905; email vlowe{at}mayo.edu

PURPOSE: Earlier detection of head and neck cancer recurrence may improve survival. We evaluated the ability of [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) to detect recurrence in a prospective trial using sequential PET scans.

PATIENTS AND METHODS: Serial posttherapy FDG-PET was prospectively performed in 44 patients with stage III or IV head and neck cancer. PET was performed twice during the first posttreatment year (at 2 and 10 months after therapy) and thereafter as needed. After therapy, patients were grouped, based on tissue biopsies, into those who achieved a complete response (CR) and those who had residual disease (RD). Patients who achieved a CR were further grouped into those without evidence of disease and those who had recurrence by 1 year after completion of therapy. Disease status as determined by physical examination (PE), PET, and correlative imaging was compared.

RESULTS: Eight patients were lost to follow-up and six had RD after therapy. Of the remaining 30 patients with a CR, 16 had recurrence in the first year after therapy. Five of these 16 patients had recurrence detected by PET only, four by PET and correlative imaging only, five by PE and PET only, and two by PE, correlative imaging, and PET. Only PET detected all recurrences in the first year. PET performed better than correlative imaging (P = .013) or PE (P = .002) in the detection of recurrence.

CONCLUSION: PET can detect head and neck tumor recurrence when it may be undetectable by other clinical methods. FDG-PET permits highly accurate detection of head and neck cancer recurrence in the posttherapy period.

Presented at the Forty-Fourth Annual Meeting of the Society of Nuclear Medicine, Toronto, Ontario, Canada, June 6-11, 1998.

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