Originally published as JCO Early Release 10.1200/JCO.2008.19.3300 on March 30 2009

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Prospective Risk-Adjusted [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography Assessment of Radiation Response in Head and Neck Cancer

From the Departments of Radiation Oncology, Pathology, Head and Neck Surgery, Diagnostic Imaging, Nuclear Medicine, Biostatistics, and Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.

Corresponding author: David L. Schwartz, MD, Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Box 97, 1515 Holcombe Blvd, Houston, TX, 77030; e-mail: docdls{at}mdanderson.org.

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.

Supported by The University of Texas M.D. Anderson Cancer Center Specialized Programs of Research Excellence (SPORE) in Head and Neck Grant No. CA97007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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