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Systematic Review/Meta-analysis
Detecting Residual/Recurrent Head Neck
Squamous Cell Carcinomas Using PETor
PET/CT: Systematic Review and Meta-
analysis
Otolaryngology–
Head and Neck Surgery
2016, Vol. 154(3) 421–432
American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2015
Reprints and permission:
sagepub.com/journalsPermissions.navDOI: 10.1177/0194599815621742
http://otojournal.orgPhylannie K. F. Cheung, BVSc, MBBS
1
,
Ronald Y. Chin, FRACS, MBBS
2
, and Guy D. Eslick, DrPH, PhD
3
No sponsorships or competing interests have been disclosed for this article.
Abstract
Objective.
To evaluate the diagnostic accuracy of positron
emission tomography (PET) and PET/computed tomography
(CT) for detecting residual and/or recurrent local and
regional disease and distant metastases in patients with head
and neck squamous cell carcinomas (HNSCCs) following
radiotherapy with or without chemotherapy.
Data Sources.
A systematic review with no language restric-
tions was conducted using PREMEDLINE, MEDLINE, EMBASE,
and Google Scholar.
Review Methods.
Only prospective studies with histopatholo-
gical and/or clinical follow-up that assessed the diagnostic
accuracy of PET and PET/CT in detecting residual and/or
recurrent disease following radiotherapy with or without
chemotherapy in patients with HNSCCs were included.
Results.
Twenty-seven studies were identified. The pooled sen-
sitivity and specificity of PET and PET/CT for detecting residual
or recurrent disease at the primary site was 86.2% and 82.3%,
respectively. For residual and recurrent neck disease, the sensi-
tivity and specificity were 72.3% and 88.3%, while for distant
metastases, the values were 84.6% and 94.9%.
Conclusions.
PET and PET/CT are highly accurate in detecting
residual and/or recurrent HNSCC. PET/CT is more specific
than PET alone. Specificity is also greater for scans per-
formed more than 12 weeks after radiotherapy with or
without chemotherapy. The authors support the use of
PET/CT after 12 weeks posttreatment for the assessment of
residual or recurrent disease.
Keywords
squamous cell carcinoma of the head and neck, locoregional
neoplasm recurrence, systematic review, meta-analysis, posi-
tron emission tomography
Received September 2, 2015; revised October 29, 2015; accepted
November 19, 2015.
S
quamous cell carcinomas (SCCs) account for more
than 90% of head and neck cancers.
1,2
Early-stage
disease is typically treated with unimodality treatment
(surgery or radiotherapy
)
, while locally advanced tumors
require a multimodality approach consisting of a combina-
tion of surgery and radiotherapy with or without chemother-
apy.
3
Despite treatment, up to 40% patients with advanced
tumors will have a locoregional recurrence,
4,5
and up to
25% will have distant metastases,
6,7
with most of these
locoregional recurrences occurring in the first 2 years post-
treatment.
8
Patients with early-stage recurrences have a
better prognosis compared with those with advanced-stage
disease.
9
Those with residual or recurrent disease confined
to the head and neck may be candidates for salvage surgery
and reirradiation. However, palliative measures may be
more appropriate for those in whom distant metastases are
present at the time of recurrence. Furthermore, the recogni-
tion of patients with a complete response postchemora-
diotherapy can reduce the need for unnecessary tissue
biopsies and neck dissections following treatment. Thus,
from a clinical perspective, the ability to accurately detect
residual or recurrent locoregional disease and exclude dis-
tant metastases is important as it can help guide ongoing
management of patients after chemoradiotherapy.
Functional imaging using 18F-fluorodeoxyglucose posi-
tron emission tomography (FDG PET) and integrated FDG
PET/computed tomography (CT) is now widely used in the
assessment of residual or recurrent disease in patients with
head and neck squamous cell carcinoma (HNSCC). As
1
Sydney Medical School, The University of Sydney, New South Wales,
Australia
2
Department of Otolaryngology Head and Neck Surgery, The University of
Sydney, Nepean Hospital, Penrith, New South Wales, Australia
3
The Whiteley-Martin Research Centre, Discipline of Surgery, The
University of Sydney, Nepean Hospital, Penrith, New South Wales,
Australia
Corresponding Author:
Ronald Y. Chin, Department of Otolaryngology Head and Neck Surgery,
The University of Sydney, Nepean Hospital,1 Hope St, Penrith, NSW 2750,
Australia.
Email:
drronaldchin@gmail.comReprinted by permission of Otolaryngol Head Neck Surg. 2016; 154(3):421-432.
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