Surveillance for recurrent head and neck cancer using positron emission tomography

Purpose: Earlier detection of head and neck cancer recurrence may improve s urvival. We evaluated the ability of [F-18]fluorodeoxyglucose positron emis sion tomography (FDG-PET) to detect recurrence in a prospective trial using sequential PET scans. Patients and Methods: Serial posttherapy FDG-PET was prospectively performe d in 44 patients with stage III or IV head and neck cancer. PET was perform ed twice during the first posttreatment year (at 2 and 10 months after ther apy) and thereafter as needed. After therapy, patients were grouped, based on tissue biopsies, into those who achieved a complete response (CR) and th ose who had residual disease (RD). Patients who achieved a CR were further grouped into those without evidence of disease and those who had recurrence by 1 year after completion of therapy. Disease status as determined by phy sical examination (PE), PET, and correlative imaging was compared. Results: Eight patients were lost to follow-up and six had Po after therapy . Of the remaining 30 patients with ct CR, 16 had recurrence in the first y ear after therapy. Five of these 16 patients had recurrence detected by PET only, four by PET and correlative imaging only, five by PE and PET only, a nd two by PE, correlative imaging, and PET. Only PET detected all recurrenc es in the first year. PET performed better than correlative imaging (P = .0 13) or PE (P = .002) in the detection of recurrence. Conclusion: PET can detect head and neck tumor recurrence when it may be un detectable by other clinical methods. FDG-PET permits highly accurate detec tion of head and neck cancer recurrence in the posttherapy period. J Clin O ncol 18:651-658. (C) 2000 by American Society of Clinical Oncology.