PET und PET/CT - Stellenwert bei Kopf-Hals-Tumoren

Zusammenfassung

Die molekulare Bildgebung durch PET basiert auf dem Einsatz spezifischer radiomarkierter Moleküle als Quelle des Bildkontrastes. In der HNO wurden am häufigsten der Glukose- und vereinzelt auch der Aminosäure- und Proteinstoffwechsel zur Tumordiagnostik mit PET verwendet. Substrate des Thymidin salvage pathway und die Proliferations- sowie Gewebshypoxiemarker haben ein hohes Potenzial zur Modulation des Strahlenfeldes bzw. zur Effizienzkontrolle zytoreduktiver Therapieschemata und werden derzeit klinisch geprüft. In dieser Kurzübersicht werden aktuelle klinische Anwendungen und Perspektiven der PET bei Kopf-Hals-Tumoren im klinischen Kontext kurz dargestellt. FDG-PET wurde zum Primärtumornachweis, zur Primärtumorsuche bei CUP-Syndrom, zum N- und M-Staging, zur Therapiekontrolle nach zytoreduktiver Therapie und zur Rezidivdiagnostik eingesetzt. Im Lymphknotenstaging und in der Rezidivdiagnostik lagen die Sensitivität und Spezifität der FDG-PET bei ca. 80-100 %. FDG-PET war in den meisten Studien der konventionellen bildgebenden Diagnostik überlegen. Beim CUP-Syndrom ließ sich ein Primärtumor bei Œ bis œ der Patienten lokalisieren. Die Fusionsbildgebung der PET und der CT in einem Kombinationsgerät hat wegen ihrer vielseitigen PET-basierten Detektionsprinzipien mit anatomisch hochauflösender und präziser CT-basierter morphologischer Bildgebung ein hohes klinisches und wissenschaftliches Potenzial.

Abstract

Molecular imaging with PET is based on the use of specific radioactive molecules as source of image contrast. In ENT-tumors mostly glucose and occasionally amino acid/protein metabolism were assessed with PET for tumor diagnosis. Thymidine salvage pathway and proliferation as well as tissue hypoxia are tested already in clinical studies and bear considerable potential for modulation of radiation ports and therapeutic response of cytoreductive regimens. This short review summarises actual clinical indications and potential of PET in ENT-tumors. For both nodal staging as well as detection of recurrent disease, sensitivity and specifity of FDG-PET were 80-100 %. FDG-PET proved to be superior to conventional imaging in most published studies. In CUP-syndrome the primary could be detected in 25-50 % of patients. Acquisition of PET and CT images in a combined scanner allow versatile PET based metabolic imaging in combination with high resolution and anatomical precise CT-based morphological imaging and thus combines advantages of both imaging modalities. Clinical as well as scientific potential of this functional metabolic and high resolution morphological imaging approach is high.

PET - PET/CT - Onkologie - HNO-Tumoren

PET - PET/CT - oncology - ENT-malignomas

Literatur

• 1 Adams S, Baum R P, Stuckensen T, Bitter K, Hor G. Prospective comparison of ¹⁸F-FDG-PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of headand neck cancer.  Eur J Nucl Med. 1998;  25 1255-1260
• 2 Ambrosch P, Kron M, Fischer G, Brinck U. Micrometastases in carcinoma of the upper aerodigstive tract: detection, risk of metastasizing, and prognostic value of depth of invasion.  Head Neck. 1995;  17 473-479
• 3 Bading J R, Kan-Mitchell J, Conti P S. System A amino acid transport in cultured human tumor cells: implications for tumor imaging with PET.  Nucl Med Biol. 1996;  23 779-786
• 4 Barrington S F, Maisy M N. Skeletal Miscle Uptake of Fluorine-18-FDG: Effect of Oral Diazepam.  J Nucl Med. 1996;  37 1127-1129
• 5 Barthel H, Cleij M, Collingridge D. et al . 3′-Deoxy-3-[¹⁸F]Fluorothymidine as a new marker for monitoring tumor response to anti-proliferate therapy in vivo with positron emission tomography.  Cancer Res. 2003;  63 3791-3798
• 6 Bataini J P. Radiotherapy in N0 head and neck cancer patients.  Eur Arch Otorhinolaryngol. 1993;  250 442-445
• 7 Bergstrom M, Lundqvist H, Ericson K. et al . Comparison of the accumulation kinetics of L-(methyl-11C)-methionine and D-(methyl-11C)-methionine in brain tumors studied with positron emission tomography .  Acta Radiol. 1987;  28 225-229
• 8 Bernier J. Chemoradiation in locally advanced head and neck cancer: new evidence, new challenges.  Expert Rev Anticancer Ther. 2004;  4 335-339
• 9 Bocca E, Pignatar O, Sasaki C T. Functional neck dissection. A description of operative technique.  Arch Otolaryngol. 1980;  106 524-527
• 10 Bragg C M. et al . The role of intensity-modulated radiotherapy in the treatment of paroid tumors.  Int J Rad Oncol Biol Phys. 2002;  52 729-738
• 11 Budach V. HNO Tumore. In: Bamberg M, Molls M, Sack H. Radioonkologie. Zuckerschwerdt, München 2004
• 12 Buckley J G, Feber T. Surgical treatment of cervical node metastases from squamous carcinoma of the upper aerodigestive tract: Evaluation of the evidence for modification of neck dissection.  Head Neck. 2001;  23 907-915
• 13 Burian M, Selzer E, Kornek G-V. Fortschritte in der Behandlung von HNO-Tumoren.  Onkologie. 2002;  25 (Suppl 1) 26-30
• 14 Calais G, Bardet E, Sire C, Alfonsi M, Bourhis J, Rhein B, Tortochaux J, Man Y T, Auvray H, Garaud P. Radiotherapy with concomitant weekly docetaxel for Stages III/IV oropharynx carcinoma. Results of the 98-02 GORTEC Phase II trial.  Int J Radiat Oncol Biol Phys. 2004;  58 161-166
• 15 Califano L, Zupi A, Mangone G M, Longo F, Coscia G, Piombino P. Surgical management of the neckin squamous cell carcinoma of the tongue.  Br J Oral Maxillofac Surg. 1999;  37 320-327
• 16 Chao K S, Deasy J O, Markman J, Haynie J, Perez C A, Purdy J A, Low D A. A prospective study of salivary function sparing in patients with head and neck cancers receiving intensity-modulated or three-dimensional radiation therapy: Initial results.  Int J Radiat Oncol Biol Phys. 2001;  49 907-916
• 17 Chao K S, Wippold F J, Ozyigit G, Tran B N, Dempsey J F. Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and postoperative IMRT.  Int J Radiat Oncol Biol Phys. 2002;  53 1174-1184
• 18 Chesnay E, Babin E, Constans J M. et al . Early Response to Chemotherapy in Hypopharyngeal Cancer: Assessment with ¹¹C-Methionine PET, Correlation with Morphologic Response, and Clinical Outcome.  J Nucl Med. 2003;  44 526-532
• 19 Chikamatsu K, Kamada H, Ninomiya H, Takahashi K, Sakurai T, Oriuchi N, Furuya N. A preliminary study on sentinel lymph node biopsy: feasibility and predictiveability in oral cavity cancer.  Ann Nucl Med. 2004;  18 257-262
• 20 Cho E I, Sasaki C T, Haffty B G. Prognostic significance of pretreatment hemoglobin for local control and overall survival in T1-T2N0 larynx cancer treated with external beam radiotherapy.  Int J Radiat Oncol Biol Phys. 2004;  58 1135-1140
• 21 Civantos F J, Gomez C, Duque C, Pedroso F, Goodwin W J, Weed D T, Arnold D, Moffat F. Sentinel node biopsy in oral cavity cancer: correlation with PET scan and immunohistochemistry.  Head Neck. 2003;  25 1-9
• 22 Cobbe N, Heck M M. Computer dating for proteins.  Heredity. 2004;  93 523-524
• 23 Cobben D C, van der Laan B F, Maas B, Vaalburg W, Suurmeijer A J, Hoekstra H J, Jager P L, Elsinga P H. ¹⁸F-FLT PET for visualization of laryngeal cancer: comparison with ¹⁸F-FDG PET.  J Nucl Med. 2004;  45 226-231
• 24 Cooper J S, Pajak T F, Forastiere A A, Jacobs J, Campbell B H, Saxman S B, Kish J A, Kim H E, Cmelak A J, Rotman M, Machtay M, Ensley J F, Chao K S, Schultz C J, Lee N, Fu K K.. Radiation Therapy Oncology Group 9501/Intergroup . Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck.  N Engl J Med. 2004;  350 1937-1944
• 25 Dawson L A, Meyers L L, Bradford C R, Chepeha D B, Hogikyan N D, Teknos Terrell J E, Wolf G T, Eisbruch A. Conformal re-irradiation of recurrent and new primary head and neck cancer.  Int J Radiat Oncol Biol Phys. 2001;  50 377-385
• 26 De Crevoisier R, Domenge C, Wibault P, Koscielny S, Lusinchi A, Janot F, Bobin S, Luboinski B, Eschwege F, Bourhis J. Full dose reirradiation combined with chemotherapy after salvage surgery in head and neck carcinoma.  Cancer. 2001;  91 2071-2076
• 27 Denis F, Geraud P, Manceau A, Beutter P, Garand G, Le Floch O, Calais G. Prognostic value of the number of involved nodes after neck dissection in oropharyngeal and oral cavity carcinoma.  Cancer Radiother. 2001;  5 12-22
• 28 DeSanto L W, Margina C, O'Fallon W M. The ‘second’ side of the neck in supraglottic cancer.  Otolaryngol Head and Neck Surg. 1990;  102 351-361
• 29 Dimery I W, Hong W K. Overview of combined modality therapies for head and neck cancer.  J Natl Cancer Inst. 1993;  85 95-111
• 30 DiNardo L J. Lymphatics of the submandibular space: An anatomic, clinical and pathologic study with applications to floor-of-mouth carcinoma.  Laryngoscope. 1998;  108 206-214
• 31 Dresel S, Grammerstorff J, Schwenzer K, Brinkbaumer K, Schmid R, Pfluger T, Hahn K. [¹⁸F] FDG imaging of head and neck tumours: comparison of hybrid PET and morphological methods.  Eur J Nucl Med Mol Imaging. 2003;  30 995-1003
• 32 Dünne A A, Budach V G, Wagner W, Werner J A. Behandlung des klinischen N0-Halses bei Plattenepithelkarzinomen der oberen Luft- und Speisewege: Aktuelle Kontroversen.  Onkologie. 2004;  27 363-367
• 33 Ferlito A, Mannara G M, Rinaldo A, Politi M, Robiony M, Costa F. Is extended selective supraomohyoid neck dissection indicated for treatment of oral cancer with clinically negative neck?.  Acta Otolaryngol. 2000;  120 792-795
• 34 Fukui M B, Blodgett T M, Meltzer C C. PET/CT imaging in recurrent head and neck cancer.  Semin Ultrasound CT MR.. 2003;  24 157-163
• 35 Garden A S, Morrison W H, Rosenthal D I, Chao K S, Ang K K. Target coverage for head and neck cancers treated with IMRT: review of clinical experiences.  Semin Radiat Oncol. 2004;  14 103-109
• 36 Gavilán C, Gavilan J. Five-year results of functional neck dissection for cancer of the larynx.  Arch Otolaryngol Head Neck Surg. 1989;  115 1193-1196
• 37 Geets X, Daisne J F, Gregoire V, Hamoir M, Lonneux M. Role of 11-C-methionine positron emission tomography for the delineation of the tumor volume in pharyngo-laryngeal squamous cell carcinoma: comparison with FDG-PET and CT.  Radiother Oncol. 2004;  71 267-273
• 38 Glatz S, Kotzerke J, Moog F, Sandherr M, Heimepl H, Reske S N. Vortäuschung eines mediastinalen Non-Hodgkin-Lymphomrezidesdurch diffuse Thymushyperplasie im ¹⁸F-FDG-PET.  Fortsch Röntgenstr. 1996;  165 309-310
• 39 Goerres G W, von Schulthess G K, Steinert H C. Why most PET of lung and head-and-neck cancer will be PET/CT.  J Nucl Med. 2004;  45 (Suppl 1) 66S-71S
• 40 Greco F A, Gray J, Burris H A, Erland J B, Morrissey L H, Hainsworth J D. Taxane-based chemotherapy for patients with carcinoma of unknown primary site.  Cancer J.. 2001;  7 203-212
• 41 Gregoire V, Levendag P, Ang K K, Bernier J, Braaksma M, Budach V, Chao C, Coche E, Cooper J S, Cosnard G, Eisbruch A, El-Sayed S, Emami B, Grau C, Hamoir M, Lee N, Maingon P, Muller K, Reychler H. CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines.  Radiother Oncol. 2003;  69 227-236
• 42 Greven K M, Williams D W, Keyes J W, McGuirt W F, Watson N E, Case L D. Can positron emission tomography distinguish tumor recurrence from irradiation sequalae in patients treated for larynx cancer?.  Cancer J Sci Am. 1997;  3 353-357
• 43 Haas I, Hoffmann T K, Engers R, Ganzer U. Diagnostic strategies in cervical carcinoma of unknown primary (CUP).  Eur Arch Otorhinolaryngol. 2002;  259 325-333
• 44 Hany T, Gharehpapahg E, Kamel E, Buck A, Himms-Hagen J, von Schulthess G K. Brown adipose tissue: a factor to consider in symmetrical tracer uptake in the neck and upper chest region.  Eur J Nucl Med. 2002;  29 1393-1398
• 45 Harper C S, Mendenhall W M, Parsons J T, Stringer S P, Cassisi N J, Million R R. Cancer in neck nodes with unknown primary site: role of mucosal radiotherapy.  Head Neck. 1990;  12 463-469
• 46 Hicks W L, Loree T R, Garcia R I, Maamoun S, Marshall D, Orner J B, Bakamjian V Y, Shedd D P. Squamous cell carcinoma of the floor of mouth: a 20-year review.  Head Neck. 1997;  19 400-405
• 47 Hunt M A. et al . Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer.  Int J Rad Oncol Biol Phys. 2001;  49 623-632
• 48 Jose J, Coatesworth A P, Johnston C, MacLennan K. Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract: the significance of extracapsular spread and soft tissue deposits.  Head Neck. 2003;  25 451-456
• 49 Khafif A, Lopez-Garza J R, Medina J E. Is dissection of level IV necessary in patients with t1-T3 N0 Tongue cancer?.  Laryngoscope. 2001;  111 1088-1090
• 50 Kitagawa Y, Nishizawa S, Sano K. et al . Prospective Comparison of ¹⁸F-FDG PET with Conventional Imaging Modalities (MRI, CT and 67Ga Scintigraphy) in Assessment of Combined Intraarterial Chemotherapy and Radiotherapy for Head and Neck Carcinoma.  J Nucl Med. 2003;  44 196-206
• 51 Kubler A C, Scheer M, Zoller J E. Photodynamic therapy of head and neck cancer.  Onkologie. 2001;  24 230-237
• 52 Kubota K, Yokoyama J, Yamaguchi K, Ono S, Qureshy A, Itoh M, Fukuda H. FDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT.  Eur J Nucl Med Mol Imaging. 2004;  31 590-595
• 53 Leibel S A, Scott C B, Mohiuddin M, Marcial V A, Coia L R, Davis L W, Fuks Z. The effect of local-regional control on distant metastatic dissemination in carcinoma of the head and neck: Results of an analysis from the RTOG head and neck database.  Int J Radiat Oncol Biol Phys. 1991;  21 549-556
• 54 Lell M, Baum U, Greess H, Nömayr A, Nkenke E, Koester M, Lenz M, Bautz W. Head and neck tumors: imaging recurrent tumor and post-therapeutic changes with CR and MRI.  Eur J Radiol. 2000;  33 239-247
• 55 Lethio K, Eskola O, Viljanen T, Oikonen V, Gronroos T, Sillanmaki L, Grenman R, Minn H. Imaging perfusion and hypoxia with PET to predict radiotherapy response in head and neck cancer.  Int J Radiat Oncol Biol Phys. 2004;  59 971-982
• 56 Levendag P, Braaksma M, Coche E, van Der Est H, Hamoir M, Muller K, Noever I, Nowak P, van Sorensen De Koste J, Gregoire V. Rotterdam and Brussels CT-based neck nodal delineation compared with the surgical levels as defined by the American Academy of Otolaryngology-Head and Neck Surgery.  Int J Radiat Oncol Biol Phys. 2004;  58 113-123
• 57 Lewis J S, McCarthy T J, Fujibayashi Y, Welch M J. Evaluation of 64-Cu-ATSM in vitro and in vivo in hypoxic tumor model.  J Nucl Med. 1999;  40 177-183
• 58 Liciardello J TW, Sptz M R, Hung W K. Multiple primary cancer in patients with cancer of the head and neck: second cancer of the head and neck, esophagus and lung.  Int J Rad Oncol Biol Phys. 1989;  17 467-476
• 59 Lowe V J, Boyd J H, Dunphy F R. et al . Surveillance for recurrent head and neck cancer using positron emission tomography.  J Clin Oncol. 2000;  18 651-658
• 60 Lowe V, Stack B. PET Imaging in Head and Neck Cancer. In: Valk P et al. (eds). Positron Emission Tomography - Basic Science and Clinical Practice. London: Springer-Verlag 2003: 536-546
• 61 Naranayan T, Said S, Mukherjee J. et al . A comparative study on the uptake and incorporation of radiolabeld methionine, choline and fluorodeoxyglucose in human astrocytoma.  Mol Imaging Biol. 2002;  4 147-156
• 62 Nigauri T, Kamata S, Kawabata K, Hoki K, Mitani H, Yoshimoto S, Yonekawa H, Miura K, Beppu T, Uchida M. Treatment strategy for cervical node metastasis from squamous cell carcinoma of the Oropharynx.  Nippon Jibiinkoka Gakkai Kaiho. 2000;  103 803-811
• 63 Nutting C M, Normile P S, Bedford J L, Harrington K J, Webb S. A systematic study of techniques for elective cervical nodal irradiation with anterior or opposed anterior and posterior beams.  Radiother Oncol. 2003;  69 43-51
• 64 Panje W R, Hier M P, Garman G R, Harrell E, Goldman A, Bloch I. Electrooperation therapy of head and neck cancer.  Ann Otol Rhinol Laryngol. 1998;  107 779-785
• 65 Patel P M, Alibazogluo H, Ali A, Fordham E, LaMonica G. Normal thymic uptake of FDG on PET imaging.  Clin Nucl Med. 1996;  21 771-775
• 66 Pernot M, Verhaeghe J L, Guillemin F, Carolus J M, Hoffstetter S, Peiffert D. Evaluation of the importance of systematic neck dissection in carcinoma of the oral cavity treated by brachytherapy alone for the primary lesion (apropos of a series of 346 patients).  Bull Cancer Radiother. 1995;  82 311-317
• 67 Perez C A, Bradley J, Chao C K, Gringsby P W, Mutic S, Malyapa R. Functional imaging in treatment planning in radiation therapy: a review.  Rays. 2002;  27 157-173
• 68 Piedbois P, Mazeron J J, Haddad E, Coste A, Martin M, Levy C, Raynal M, Pavlovitch J M, Peynegre R, Pierquin B. et al . Stage I-II squamous cell carcinoma of the oral cavity treated by iridium-192: is elective neck dissection indicated?.  Radiother Oncol. 1991;  21 100-106
• 69 Pignon J P, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: Three meta-analysis of updated individual data. MACHNC Collaboration Group Meta-Analysis of Chemotherapy on Head and Neck Cancer.  Lancet. 2000;  355 949-955
• 70 Rabuzzi D D, Chung C T, Sagerman R H. Prophylactic neck irradiation.  Arch Otolaryngol. 1980;  106 454-455
• 71 Rasey J S, Hofstrand P D, Chin L K, Tewson T J. Characterization of [¹⁸F]fluoroetanidazole, a new radiopharmaceutical for detecting tumor hypoxia.  J Nucl Med. 1999;  40 1072-1079
• 72 Reske S N, Kotzerke J. FDG-PET for clinical use. Results of the 3^rd German Interdisciplinary Consensus Conference, “Onco-PET III”, 21 July and 19 September 2000.  Eur J Nucl Med. 2001;  28 1707-1723
• 73 Reske S N, Dankerl A, Glatting G, Mottaghy F M, Blumstein N M. Stellenwert der PET bei Kopf-Hals-Tumoren.  Laryngol-Rhino-Otol. 2004;  83 391-406
• 74 Riess H, Wust P. Tumoren des Kopf- und Halsbereichs. In: Wilmanns W, Huhn D, Wilms K (eds). Internistische Onkologie. Thieme, Stuttgart, New York 1994; 572-583
• 75 Rogers S N, Devine J, Lowe D, Shokar P, Brown J S, Vaugman E D. Longitudinal health-related quality of life after mandibular resection for oral cancer: a comparison between rim and segment.  Head Neck. 2004;  26 54-62
• 76 Scarfone C, Lavely W C, Cmelak A J, Delbeke D, Martin W H, Billheimer D, Hallahan D E. Prospective feasibility trial of radiotherapy target definition for head and neck cancer using 3-dimensional PET and CT imaging.  J Nucl Med. 2004;  45 543-552
• 77 Schmoll H, Höffken K, Possinger K. Kompendium Internistische Onkologie, Standards in Diagnostik und Therapie. Springer, Berlin, Heidelberg 2002
• 78 Schoder H, Yeung H W. Positron emission imaging of head and neck cancer, including thyroid carcinoma.  Semin Nucl Med. 2004;  34 180-197
• 79 Seeber S, Schütte J. (Hrsg) .Therapiekonzepte Onkologie. 4. Auflage. Springer, Heidelberg 2003
• 80 Shah P M, Shukla S N, Patel K M, Patel N L, Baboo H A, Patel D D. Effect of bleomycin-radiotherapy combination in management of head and neck squamous cell carcinoma.  Cancer. 1981;  48 1106-1109
• 81 Shields A F, Mankoff D A, Link J M. et al . Carbon-11-thymidine and FDG to measure therapy response.  J Nucl Med. 1998;  39 1757-1762
• 82 Spencer S A, Harris J, Wheeler R H, Machtay M, Schultz C, Spanos W, Rotman M, Meredith R. RTOG 96-10: reirradiation with concurrent hydroxyurea and 5-fluorouracil in patients with squamous cell cancer of the head and neck.  Int J Radiat Oncol Biol Phys. 2001;  51 1299-1304
• 83 Stoeckli S J, Steiner H, Pfaltz M, Schmid S. Sentinel node evaluation in squamous cell carcinoma of the head and neck.  Otolaryngol Head Neck Surg. 2001;  125 221-226
• 84 Tankere F, Camproux A, Barry B, Guedon C, Depondt J, Gehanno P. Prognostic value of lymph node involvement in oral cancers: a study of 137 cases.  Laryngoscope. 2000;  110 2061-2065
• 85 Van den Brekel M W, Castelijns J A, Stel H V, Golding R P, Meyer C J, Snow G B. Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: A prospective comparative study.  Eur Arch Otorhinolaryngol. 1993;  250 11-17
• 86 Vartanian J G, Pontes E, Agra I M, Campos O D, Goncalves-Filho J, Carvalho A L, Kowalski L P. Distribution of metastatic lymph nodesin oropharyngeal carcinoma and its implication for the elective treatment of the neck.  Arch Otolaryngol Head Neck Surg. 2003;  129 729-732
• 87 Wittekind C, Meyer H, Bootz F. TNM - Klassifikation maligner Tumoren. Springer, Berlin, Heidelberg 2003
• 88 Wong L Y, Wei W I, Lam L K, Yuen A P. Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery.  Head Neck. 2003;  25 953-959
• 89 Wu G H, Chen F J, Zheng Z Y, Li H, Song M, Wie M W, Xue G P, Guo Z M, Zhang Q, Yang A K, Cheng W K. Indication and clinical radical effect of functional neck dissection for head and neck neoplasm.  Ai Zheng. 2002;  21 654-657
• 90 Yao M, Graham M M, Hoffman H T, Smith R B, Funk G F, Graham S M, Dornfeld K J, Skwarchuk M, Menda Y, Buatti J M. The role of post-radiation therapy FDG PET in prediction of necessity for post-radiation therapy neck dissection in locally advanced head-and-neck squamous cell carcinoma.  Int J Radiat Oncol Biol Phys. 2004;  59 1001-1010
• 91 Zimny M, Wildberger J E, Cremerius U, Di Martino E, Jaenicke S, Nowak B, Büll U. Combined imaging interpretation of computed PET in head and neck cancer.  Nuklearmedizin. 2002;  41 14-21