Nuklearmedizin 2019; 58(02): 93-100
DOI: 10.1055/a-0859-6518
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of subjective evaluation versus objective algorithm in the interpretation of follow-up FDG-PET/CT scans after radiochemotherapy in head and neck cancer patients

Vergleich der subjektiven Auswertung mit einem objektiven Algorithmus in der Interpretation von FDG-PET/CT-Untersuchungen in der Nachsorge von Patienten mit Kopf-Hals-Tumoren nach Radiochemotherapie
Alexander Kohler
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Steffen Löck
2   Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
3   National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
,
Steffen Appold
2   Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Anna Bandurska-Luque
2   Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
3   National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
,
Sebastian Hoberück
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Andreas Schreiber
4   Department of Radiotherapy, Hospital Dresden-Friedrichstadt, Dresden, Germany
,
Jörg Kotzerke
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
3   National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
,
Daniel Zips*
5   Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
,
Klaus Zöphel*
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
3   National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

11/16/2018

02/18/2019

Publikationsdatum:
27. März 2019 (online)

Abstract

Aim Retrospective evaluation of serial FDG-PET/CT scans in head and neck squamous cell cancer (HNSCC) patient’s follow-up after primary radiochemotherapy (RCTx), to assess the diagnostic accuracy of an experienced observer vs. an objective classification compared to standard clinical follow-up examinations.

Methods Sixty-nine patients with locally advanced HNSCC were included, who received curative RCTx. Follow-up included serial FDG-PET/CT at the following time intervals t1: ≤ 270 d, t2: 271–540 d, t3: > 540 d after curative RCTx. The likelihood to detect local recurrences, nodal and distant metastases were compared between (i) experienced observer, (ii) an objective classification system by Zundel et al. [25], and (iii) routine clinical follow-up examinations.

Results Twenty-two local recurrences, 7 nodal and 17 distant metastases were recorded during the follow-up. The diagnostic accuracy for local recurrence of the experienced observer vs. objective classification was 78 % vs. 77 % for t1, 83 % vs. 79 % for t2 and 100 % vs. 84 % for t3.

The classification (ii) and the conventional follow-up (iii) resulted in a relatively high amount of equivocal findings reducing the diagnostic accuracy.

Conclusion Evaluation of FDG-PET/CT by an experienced observer in follow-up of HNSCC patients after curative RCTx resulted in the highest diagnostic accuracy in comparison to an objective classification and to routine clinical examination.

HNSCC is a malignant tumor with a high likelihood of recurrence, especially in the first two years after curative RCTx. Early detection of recurrence is of high clinical importance, since there are several effective second line therapies that may have curative potential in some patients.

Zusammenfassung

Ziel Retrospektive Analyse der FDG-PET/CT in der Nachsorge von Patienten mit primär radiochemotherapierten zervikalen Plattenepithelkarzinomen (HNSCC). Vergleich der diagnostischen Genauigkeit des erfahrenen Befunders mit einem objektiven Klassifizierungssystem und mit der klinischen Nachsorgeuntersuchung.

Methoden 69 Patienten, die wegen eines lokal fortgeschrittenen HNSCC eine kurative Radiochemotherapie (RCTx) erhielten, wurden eingeschlossen. Die Nachsorge umfasste serielle FDG-PET/CT nach RCTx zu folgenden Zeitintervallen t1: ≤ 270 d, t2: 271–540 d, t3: > 540 d. Die Detektionsraten von Lokalrezidiven, Lymphknoten- und Fernmetastasen durch den erfahrenen Befunder (i), das objektive Klassifikationsverfahren (ii) nach Zundel [25] sowie durch die routinemäßige klinische Nachsorge (iii) wurden verglichen.

Ergebnisse Insgesamt wurden 22 Patienten mit Lokalrezidiven, 7 mit Lymphknoten-, und 17 mit Fernmetastasen detektiert. Die diagnostischen Genauigkeiten des erfahrenen Untersuchers (i) und des objektiven Klassifizierungssystems (ii) bezüglich der Lokalrezidive betrugen 78 % und 77 % zu t1, 83 % bzw. 79 % zu t2 und 100 % bzw. 84 % zu t3. Das Klassifizierungssystem nach Zundel, aber auch die konventionelle Nachsorgeuntersuchung führte zu einem relativ hohen Anteil uneindeutiger Befunde, was sich negativ auf die diagnostische Genauigkeit auswirkte.

Schlussfolgerung Die Auswertung der FDG-PET/CT bei Patienten mit lokal fortgeschrittenen HNSCC nach kurativer RCTx durch den erfahrenen Befunder hat die höchste diagnostische Genauigkeit für die Detektion von Lokalrezidiven und/oder Metastasen im Vergleich zu einem objektiven Klassifizierungssystem und der routinemäßigen klinischen Nachsorge.

Vor dem Hintergrund zahlreicher effektiver Zweitlinientherapien mit teils kurativem Potenzial und der hohen Rezidivneigung in den ersten beiden Jahren nach Primärtherapie ist die frühzeitige und exakte Detektion von Rezidiven und Metastasen bei HNSCC-Patienten von großer Bedeutung.

* These authors share the senior authorship.


 
  • Literature

  • 1 Abgral R, Querellou S, Potard G. et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up?. Journal of nuclear medicine 2009; 50: 24-29
  • 2 Abramyuk A, Appold S, Zophel K. et al. Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy. Strahlentherapie und Onkologie 2013; 189: 197-201
  • 3 Abramyuk A, Wolf G, Shakirin G. et al. Preliminary assessment of dynamic contrast-enhanced CT implementation in pretreatment FDG-PET/CT for outcome prediction in head and neck tumors. Acta radiologica 2010; 51: 793-799
  • 4 Andrade RS, Heron DE, Degirmenci B. et al. Posttreatment assessment of response using FDG-PET/CT for patients treated with definitive radiation therapy for head and neck cancers. International journal of radiation oncology, biology, physics 2006; 65: 1315-1322
  • 5 Bertz J. (Hrsg) Verbreitung von Krebserkrankungen in Deutschland. Entwicklung der Prävalenzen zwischen 1990 und 2010; eine Veröffentlichung des Zentrums für Krebsregisterdaten am RKI. Robert-Koch-Inst; Berlin: 2010
  • 6 Bourhis J, Sire C, Graff P. et al. Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99–02). An open-label phase 3 randomised trial. The Lancet Oncology 2012; 13: 145-153
  • 7 Bree R de, Hoekstra OS. Evaluation of neck node response after radiotherapy: minimizing equivocal results. European journal of nuclear medicine and molecular imaging 2016; 43: 605-608
  • 8 Budach V, Stuschke M, Budach W. et al. Hyperfractionated accelerated chemoradiation with concurrent fluorouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer: final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95–06 Prospective Randomized Trial. Journal of clinical oncology 2005; 23: 1125-1135
  • 9 Hentschel M, Appold S, Schreiber A. et al. Early FDG PET at 10 or 20 Gy under chemoradiotherapy is prognostic for locoregional control and overall survival in patients with head and neck cancer. European journal of nuclear medicine and molecular imaging 2011; 38: 1203-1211
  • 10 Hentschel M, Appold S, Schreiber A. et al. Serial FDG-PET on patients with head and neck cancer: implications for radiation therapy. International journal of radiation biology 2009; 85: 796-804
  • 11 Ho AS, Tsao GJ, Chen FW. et al. Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence. Cancer 2013; 119: 1349-1356
  • 12 Hustinx R, Lucignani G. PET/CT in head and neck cancer: an update. European journal of nuclear medicine and molecular imaging 2010; 37: 645-651
  • 13 Leger S, Zwanenburg A, Pilz K. et al. A comparative study of machine learning methods for time-to-event survival data for radiomics risk modelling. Scientific reports 2017; 7: 13206
  • 14 Mehanna H, Wong WL, McConkey CC. et al. PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer. The New England journal of medicine 2016; 374: 1444-1454
  • 15 Ong SC, Schoder H, Lee NY. et al. Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for Locoregional advanced head and neck cancer. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2008; 49: 532-540
  • 16 Paidpally V, Tahari AK, Lam S. et al. Addition of 18F-FDG PET/CT to clinical assessment predicts overall survival in HNSCC: a retrospective analysis with follow-up for 12 years. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2013; 54: 2039-2045
  • 17 Quon A, Fischbein NJ, McDougall IR. et al. Clinical role of 18F-FDG PET/CT in the management of squamous cell carcinoma of the head and neck and thyroid carcinoma. Journal of nuclear medicine 2007; 48 (Suppl. 01) 58S-67S
  • 18 Schaarschmidt BM, Heusch P, Buchbender C. et al. Locoregional tumor evaluation of squamous cell carcinoma in the head and neck area: a comparison between MRI, PET/CT and integrated PET/MRI. European journal of nuclear medicine and molecular imaging 2016; 43: 92-102
  • 19 Sherriff JM, Ogunremi B, Colley S. et al. The role of positron emission tomography/CT imaging in head and neck cancer patients after radical chemoradiotherapy. The British journal of radiology 2012; 85: e1120-6
  • 20 Wolff K-D, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. Deutsches Ärzteblatt international 2012; 109: 829-835
  • 21 Wolff KD, Bootz F, Beck J. et al. Mundhöhlenkarzinom – Diagnostik und Therapie des Mundhöhlenkarzinoms (2012). Im Internet: http://www.awmf.org/leitlinien/detail/ll/007–100OL.html Stand: 19.10.2017
  • 22 Xu GZ, Guan DJ, He ZY. (18)FDG-PET/CT for detecting distant metastases and second primary cancers in patients with head and neck cancer. A meta-analysis. Oral oncology 2011; 47: 560-565
  • 23 Zips D, Zöphel K, Abolmaali N. et al. Exploratory prospective trial of hypoxia-specific PET imaging during radiochemotherapy in patients with locally advanced head-and-neck cancer. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 2012; 105: 21-28
  • 24 Zöphel K, Appold S, Abolmaali N. PET/CT-basierte Bestrahlungsplanung bei Patienten mit Kopf-Hals-Tumoren. Nuklearmediziner 2008; 31: 55-59
  • 25 Zundel MT, Michel MA, Schultz CJ. et al. Comparison of physical examination and fluorodeoxyglucose positron emission tomography/computed tomography 4–6 months after radiotherapy to assess residual head-and-neck cancer. International journal of radiation oncology, biology, physics 2011; 81: 32