Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy
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uk1, 4 · S. Appold2 · K. Zöphel3 · M. Baumann1, 2 · N. Abolmaali1, 5 1 OncoRay – National Center for Radiation Research in Oncology, Biological and Molecular
Imaging, Medical Faculty and University Hospital Carl Gustav Carus, Dresden 2 Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden 3 Clinic and Policlinic for Nuclear Medicine, Medical Faculty and
University Hospital Carl Gustav Carus, Dresden 4 Institute and Policlinic of Diagnostic Radiology, Department of Neuroradiology,
Medical Faculty and University Hospital Carl Gustav Carus, Dresden 5 Institute and Policlinic of Diagnostic Radiology, Medical Faculty
and University Hospital Carl Gustav Carus, Dresden
Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy Reliable tumor staging is a fundamental pre-requisite for efficient tumor therapy and patient prognosis [10, 23, 24, 29]. Modification of initial staging has impact on the radiotherapy (RT) planning and particularly in terms of M staging on radiotherapeutic intention [11, 21, 25]. Computed tomography (CT) and magnetic resonance imaging (MRI) are preferentially used for staging of head and neck cancer (HNC). Both modalities, relaying on certain morphological criteria like size and contrast enhancement pattern, provide anatomic information about locoregional tumor status as well as distant metastases [16, 17, 19, 34]. However, these criteria are not very specific. The current size criterion of 1 cm or larger misinterprets the majority of all metastases. According to van den Brekel et al. [31] more than 30% of all lymph node metastases are localized in nodes smaller than 1.0 cm in diameter. Moreover, it was shown that for the palpably N0 neck, for level II a criterion of 7 mm was optimal, whereas for the rest of the neck, lymph nodes with a minimal diameter of 6 mm should be considered suspicious [30]. Otherwise, 40% of lymph nodes larger than 1 cm were demonstrated to be benign [28]. Using 10 mm diameter as the threshold, the quoted specificities are as low as 39% and 48% for CT and MRI, respectively, for the detection of nodal metastases
in HNC [4]. In the meantime, fluorine18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) combined with CT in a single device (FDGPET/CT) was shown to be highly accurate and efficient diagnostic approach by staging of different tumor entities [1, 2, 6, 7, 33]. Delivering little information on T-stage following anatomical imaging, FDG-PET/CT provides important additional information concerning N and M stage of disease [27, 32]. In case of nodal staging, agreement between the imaging results and pathology findings is stronger for FDG-PET/CT (0.95, 95% confidence interval [CI] 0.82–0.99) than for CT imaging alone (0.81, 95% CI 0.63–0.91) [27]. FDG-PET/CT improves the standardization of volume determination in RT planning. In a prospective study by Ciernik et al. [3] implementation of FDG-PET/CT into tumor volume delineation decreases the standard deviation of in
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