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Use of 18F-Fludeoxyglucose–Positron Emission Tomography/Computed Tomography for Patient Management and Outcome in Oropharyngeal Squamous Cell Carcinoma A Review

Mehdi Taghipour, MD1; Sara Sheikhbahaei, MD, MPH1; Wael Marashdeh, MD1; Lilja Solnes, MD1; Anna Kiess, MD, PhD2,3; Rathan M. Subramaniam, MD, PhD, MPH1,3,4,5
[+] Author Affiliations
1Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
2Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
3Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
4Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
5Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2016;142(1):79-85. doi:10.1001/jamaoto.2015.2607.
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18F-fludeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) has been performed widely in diagnosis and management of patients with oropharyngeal squamous cell carcinoma (OPSCC). This review summarizes the literature on this tool in the management of these patients. The use of FDG-PET/CT helps in accurate staging of primary tumor, nodal involvement, and distant metastasis of patients with OPSCC. Contrast-enhanced FDG-PET/CT combines high-resolution CT and functional FDG-PET, providing the optimum imaging information for patient management. Using contrast-enhanced PET/CT leads to a combined anatomic and metabolic approach to radiation therapy planning in OPSCC. Moreover, PET/CT not only is a good modality for therapy assessment but also is a powerful tool in early recurrence detection of OPSCC. Finally, the PET/CT parameters provide survival information in patients with OPSCC; however, further studies are needed to introduce a scoring system to use clinically for prognosis prediction.

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Figure 1.
Nodal Staging in Patient With Clinically N0 Disease

Axial fused positron emission tomography/computed tomography images of initial scan of a man in his 60s with a diagnosis of squamous cell carcinoma of the base of the tongue, extending to the soft palate and retromolar trigone on the right side. The 18F-fludeoxyglucose–positron emission tomography/computed tomography scan was performed to stage the disease. A, Intense fludeoxyglucose uptake in the oropharyngeal tumor (standard uptake value, 12.83) (arrowhead). B, Intense fludeoxyglucose uptake in 1 ipsilateral hypermetabolic level II (standard uptake value, 5.26) lymph node (arrowhead). The patient was treated with radiation therapy (6000 cGy) and chemotherapy (7 weeks cetuximab), but because of persistent local disease, weekly palliative chemotherapy (weekly docetaxel) was continued. His last follow-up in our center was 7 months after completion of primary treatment.

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Figure 2.
Value of Positron Emission Tomography/Computed Tomography (PET/CT) in Detecting Distant Metastasis and Second Primary Cancer in Patients With Oropharyngeal Squamous Cell Carcinoma

A and B, Axial fused PET/CT) images of initial scan of a man in his 60s with a diagnosis of poorly differentiated squamous cell carcinoma of the oropharynx. A, The PET/CT scan demonstrated an intensely fludeoxyglucose (FDG)-avid primary lesion (standard uptake value [SUV], 36.5) (blue arrowhead); fludeoxyglucose-avid metastasis to regional neck nodes (SUV, 11.8) (red arrowhead). B, Fludeoxyglucose-avid lung metastasis (SUV, 4.4) (arrowhead). C and D, Axial fused PET/CT image of initial PET/CT scan of a man in his 60s who presented with a mass in the right tonsil; PET/CT scan was performed for staging and evaluation for metastatic disease. C, The FDG PET/CT scan demonstrated an intensely FDG-avid lesion within the region of the right palatine tonsil (SUV, 9.3) (arrowhead). D, In addition, it revealed another moderately FDG-avid lung lesion (SUV, 7.45) (arrowhead) in the right upper lobe compatible with synchronous primary lung carcinoma, which biopsy proved to be an adenocarcinoma of the lung.

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Figure 3.
Value of Positron Emission Tomography/Computed Tomography (PET/CT) in Radiation Therapy Planning for Oropharyngeal Squamous Cell Carcinoma (OPSCC)

Imaging of a man in his 50s who received a diagnosis of stage cT3N2cM0 human papillomavirus–negative OPSCC. A, Pretreatment PET/CT. B, Simulation CT. These were fused for radiation therapy planning, which aided in identifying gross tumor volumes (yellow), including posterior oropharyngeal primary, bulky adenopathy of the right side of the neck with central necrosis, and small left neck nodes that did not meet CT size criteria but were FDG avid. Planning target volumes were prescribed 70 Gy (red) and 60 Gy (blue). C, The resulting intensity-modulated radiotherapy plan was conformal to the target contours, and the patient had a complete response to treatment.

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Figure 4.
Therapy Assessment

A, Axial fused positron emission tomography/computed tomography (PET/CT) image of initial scan of a man in his 60s with a history of left tongue base squamous cell carcinoma, which presented as a fludeoxyglucose-avid lesion (standard uptake value, 9.99) (arrowhead) in PET/CT. The patient was treated with chemoradiation (9 weeks cetuximab, 7000 cGy). B, Three months after treatment, PET/CT scan showed good response with diffuse uptake suggestive of postradiotherapy inflammation (diffuse uptake, standard uptake value, 6.74). C, The 9-month follow-up PET/CT showed complete response without any interval treatment.

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