Impact of positron emission tomography on the initial staging and therapy in locoregional advanced squamous cell carcinoma of the head and neck
Daniel T Schmid, Sandro Stöckli, Florian Bandhauer, Pia Huguenin, Stephan Schmid, Gustav K Von Schulthess & Gerhard W Goerres
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abstract
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OBJECTIVE: To evaluate the impact of 18F-fluoro-deoxy-glucose
positron emission tomography after standard diagnostic workup in
patients with advanced head and neck squamous cell carcinoma on
staging and radiation treatment planning. STUDY DESIGN: Prospective
controlled study. METHODS: Forty-eight patients (42 men and 6 women;
mean age, 61 y; age range, 35-85 y) with histologically confirmed,
advanced-stage (any T, N> or =N2 or T> or =T3, any N) mucosal
head and neck squamous cell carcinoma underwent positron emission
tomography. The routine workup consisting of physical examination,
panendoscopy, chest x-ray film, and contrast-enhanced
high-resolution helical computed tomography scan (HRCT) was used for
comparison. End points were the extent of lymph node disease,
distant metastases, and second primary tumors. RESULTS: In 41 of 48
patients (85%) the lymph node findings between HRCT and positron
emission tomography were concordant. In three patients positron
emission tomography led to an upstaging of the tumor in its N
category, and in four patients positron emission tomography
underestimated lymph node involvement. Positron emission tomography
revealed more difficulties in delineating lymph node metastases
adjacent to the primary tumor than did HRCT, but was superior for
the detection of distant and contralateral lymph node metastases.
Positron emission tomography suggested distant metastatic lesions in
6 of 48 patients (13%). Cytological workup confirmed distant
metastases in two (4%) and second primary tumors in another two
patients (4%). Positron emission tomography results were
false-positive in two (4%) patients because of inflammatory changes.
CONCLUSIONS: Whole-body PET is able to assess lymph node
involvement, distant metastases, and second primaries in a single
study. Even after a routine clinical staging, positron emission
tomography leads to a change of treatment in approximately 8% of
patients.
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citation
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Schmid D T, Stöckli S, Bandhauer F, Huguenin P, Schmid S, Von
Schulthess G K, Goerres G W. Impact of positron emission tomography
on the initial staging and therapy in locoregional advanced squamous
cell carcinoma of the head and neck. The Laryngoscope 2003;
113:888-91.
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type
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journal paper/review (English)
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date of publishing
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5-2003
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journal title
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The Laryngoscope (113/5)
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ISSN print
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0023-852X
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pages
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888-91
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PubMed
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12792328
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DOI
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10.1097/00005537-200305000-00021
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