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Positron emission tomography ( PET ) and conventional computed tomography ( CT ) is an effective tool for detecting early asymptomatic recurrent disease.

PET and conventional CT is an effective tool for detecting early asymptomatic recurrent disease, according to a study presented here on September 27 at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2010.

Head and neck cancer patients are at greatest risk of recurrence within the first 5 years of treatment, but early detection of recurrent disease in patients with a benign exam, and no symptoms, is a challenge, according to findings presented during a poster session by Mark Varvares, MD, Department of Otolaryngology-Head and Neck Surgery, St. Louis University, St. Louis, Missouri, and colleagues.

Previous studies have shown the PET-CT imaging modality to be more accurate than PET alone. And, it could detect disease that would otherwise not be identified upon physical exam or by patient-reported symptoms. The researchers recently reported the effectiveness of fluorodeoxyglucose (FDG) PET - CT in detecting an asymptomatic recurrence in a group of previously treated head and neck cancer patients. This report is a follow-up study reporting the survival outcomes in this group once the recurrence was detected.

A retrospective review was performed on a series of head and neck cancer patients (n = 123) at a single institution between February 2004 and July 2007 who had undergone non-staging FDG- PET - CT scans as an integral part of the patient's follow up after having received definitive treatment. Each scan (n = 308) was evaluated by a board-certified nuclear medicine physician and final scan readings from each patient's medical record were reviewed for this study.

Lesions were defined as primary, regional, or distant site. Each positive lesion was confirmed clinically or histologically, and each positive lesion was then retrospectively defined as symptomatic or asymptomatic based on clinic notes. Lesions were considered to be an asymptomatic recurrence if the patient had no symptoms or physical findings at the time of the scan. The patients who were identified as having an asymptomatic recurrence were then followed until the time of their last follow-up visit, or death.

The majority of patients evaluated had squamous cell carcinoma of the oral cavity, pharynx, and larynx. There were 96 (78%) male patients and 27 (22%) female patients. A total of 616 lesions on 308 scans were evaluated. Of those scans, 25 (8%) detected asymptomatic disease; 33 (5%) represented asymptomatic recurrent disease. Asymptomatic lesions were detected most frequently at distant sites with 52% being thoracic, but also included primary (6%), regional (9%), and other (33%) sites. These lesions were found in 24 (20%) of the patients evaluated. At last follow-up of the 24 patients where asymptomatic recurrence was detected, 9 remain alive, 5 with disease. The remainder of the group has died of malignant disease.

"Determining an effective surveillance regimen is the goal for future management of head and neck malignancies; prospective studies are necessary to determine if PET - CT imaging modality will be part of this routine," Dr. Varvares noted.

Source: DG News

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