2017 Section 7 Green Book

A population-based cohort study of 75 087 patients with head

and neck SCC reported that the rate of developing second primary

cancer in patients with OPSCC has decreased to the lowest levels

of any subtype and claimed that this is because of the increasing rate

of HPV-related OPSCC.

Gan et al

reported that smoking status

(former, current, or nonsmoker) was an important factor in devel-

oping a second primary cancer in patients with OPSCC, and Rodri-

guez-Bruno et al

recommended not performing routine panen-

doscopyfordetectionofsecondprimarytumorinpatientswhonever

have smoked. In general, it seems that because of the increasing in-

cidence of HPV-related OPSCC and the low rate of a second pri-

mary cancer in this subgroup of patients, future studies are needed

toprovide a guideline for secondprimary cancer screening inOPSCC

according to HPV and smoking status (Figure 2C and D).

Value of Contrast-Enhanced Head and Neck

PET/CT in Staging

The TNMstaging of OPSCC is an essential factor for determining sur-

gical and radiation treatment strategies. Aside fromanatomic evalu-

ation of the tumor with CT and MRI, assessment of metabolic fea-

tures seems to be important for accurate staging of head and neck

cancers. As noted, PET scan provides advantages over anatomic

imaging in the assessment of the primary tumor and cervical me-

tastasis; in addition, PET is capable of detecting distant metastasis

or a second primary tumor, if present. Altogether, PET increases the

accuracy of pretreatment staging of OPSCC.

It is known that PET alone or PET/CTwithout contrast does not

provide sufficient anatomic detail for surgical planning. Krabbe et

reported that performing a single PET/CT with contrast instead

of a separate PET/CTwithout contrast and neck CTwith contrast in

initial staging of OPSCC has several advantages, such as providing

fully optimized head and neck CT, reduced radiation dose, de-

creased false-positive results, and increased confidence for stag-

ing. Other advantages are improved lesion conspicuity, precise tu-

mor delineation, evaluation of resectability of primary lesions, and

detection of distant metastasis such as liver metastases. These ad-

vantages of PET/CT with contrast have been shown to change ini-

tial oncological management compared with PET/CT without

contrast.

In addition, it is less efficient to prepare 2 images sepa-

rately andwrite 2 separate reports, and if 2 different radiologists re-

port separately, the other physicians may see conflicting interpre-

tations that could lead to treatment delay.

It has been shown that

baseline contrast-enhancedPET/CTdecreases theneed for a supple-

mentary contrast CT scan and can provide both high-quality ana-

tomic and functional information in a single study. Today, it is rec-

ommended that a single contrast-enhanced PET/CT study be

performed for initial assessment and staging of patients with

OPSCC.

Value of PET/CT in Therapy Planning for OPSCC

Radiotherapy with or without chemotherapy is the mainstay of

therapy for advancedOPSCC. To decrease the adverse effects of ra-

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.

Use of FDG-PET/CT in Oropharyngeal Squamous Cell Carcinoma

Review

Clinical Review & Education

jamaotolaryngology.com

(Reprinted)

JAMA Otolaryngology–Head & Neck Surgery

January 2016 Volume 142, Number 1