2017 Section 7 Green Book

Use of

F-Fludeoxyglucose–Positron Emission

Tomography/Computed Tomography for Patient Management

and Outcome in Oropharyngeal Squamous Cell Carcinoma

A Review

Mehdi Taghipour, MD; Sara Sheikhbahaei, MD, MPH; Wael Marashdeh, MD; Lilja Solnes, MD; Anna Kiess, MD, PhD;

Rathan M. Subramaniam, MD, PhD, MPH

ead and neck cancers are the sixth most common malig-

nant neoplasms globally. Despite an improvement in can-

cer detection and treatmentmethods, they are still a sub-

stantial healthcareproblem

andapproximately650 000newcases

aredetectedannually,with350 000deaths yearlyworldwide.

Oro-

pharyngeal cancer is the most common subtype of head and neck

cancers, andoropharyngeal cancers account for approximately 25%

of head and neck cancers in the United States.

Almost all oropha-

ryngeal cancers are squamous cell carcinomas (SCCs).

Smoking and alcohol use are themost important risk factors for

oropharyngeal squamous cell carcinoma (OPSCC). Alcohol syner-

gistically increases the carcinogenic effect of smoking. This carci-

nogenic effect is dose dependent for both alcohol and smoking. Hu-

man papillomavirus (HPV) infection, mainly HPV type 16, plays an

important role in the etiology of head and neck cancers, especially

OPSCC.

The incidence of HPV-related OPSCC has increased, and

the palatine tonsils and base of the tongue are the most common

sites of HPV-related head and neck cancers. Some studies have

reported that as many as 72% of OPSCCs are positive for HPV.

Studies have shown that HPV-related squamous cell carcinoma

(SCC) is epidemiologically, clinically, and biologically different

from HPV-negative SCC. The former occurs more frequently in

younger patients, predominantly in males and whites, and is asso-

ciated with sexual behavior.

Human papillomavirus–related

OPSCC is histologically different from HPV-negative disease, as it

presents with higher mitotic rate, poor differentiation, no kerati-

nization, and distinct basaloid appearance. Both prospective and

retrospective studies, as well as meta-analysis, have confirmed

better survival rates in patients with HPV-related OPSCC com-

pared with HPV-negative disease, either with surgical or nonsur-

gical management.

F-fludeoxyglucose–positron emission tomography/

computed tomography (FDG-PET/CT) has been proven to be

valuable in the management of many human solid tumors.

8,9

The

purpose of this article was to review the literature to assess the

value of FDG-PET/CT in the management of patients with OPSCC.

A PubMed search was performed using the search terms “posi-

tron emission tomography” or “PET” or “PET/CT,” “oropharyngeal

neoplasm” or “oropharyngeal cancer,” “oropharyngeal squamous

cell carcinoma,” “head and neck neoplasm,” “staging,” “therapy

planing,” “therapy assessment,” “survival,” or “prognosis” without

restriction or filter for all relevant articles published through

December 31, 2014.

Value of PET/CT in Primary Tumor Detection

Uptake of FDG in primary tumors depends on variable factors in-

cluding tumor type, size, proliferation rate, and ratio of viable vs ne-

crotic cells.

The overall sensitivity and specificity of PET scans in

detecting primary tumor is greater than 90%, especially if a con-

trast CT scan is added to PET.

For primary tumor detection, CT and

magnetic resonance imaging (MRI) effectively localize large tu-

mors, but for small tumors PET is more effective

because of in-

F-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.

JAMA Otolaryngol Head Neck Surg

. 2016;142(1):79-85. doi

: 10.1001/jamaoto.2015.2607

Published online November 19, 2015.

Supplemental content

jamaotolaryngology.com

Author Affiliations:

Author

affiliations are listed at the end of this

article.

Corresponding Author:

Rathan M.

Subramaniam, MD, PhD, MPH,

Russell H. Morgan Department of

Radiology and Radiology Science,

Johns Hopkins Medical Institutions,

601 N Caroline St, JHOC 3235,

Baltimore, MD 21287

( rsubram4@jhmi.edu )

Review

jamaotolaryngology.com

(Reprinted)

JAMA Otolaryngology–Head & Neck Surgery

January 2016 Volume 142, Number 1

Reprinted by permission of JAMA Otolaryngol Head Neck Surg. 2016; 142(1):79-85.