Upfront PET/CT affects management decisions in patients with recurrent head and neck squamous cell carcinoma

•PET/CT changes management decisions in one-third of patients.•A greater share of patients is allocated to palliative treatment by PET/CT.•PET/CT may ensure successful management for more patients. To compare multidisciplinary team conference (MDTC) decisions regarding treatment intent based on eith...

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Published in:Oral oncology 2019-07, Vol.94, p.1-7
Main Authors: Rohde, Max, Nielsen, Anne L., Johansen, Jørgen, Sørensen, Jens A., Diaz, Anabel, Pareek, Manan, Asmussen, Jon T., Gerke, Oke, Thomassen, Anders, Gyldenkerne, Niels, Døssing, Helle, Bjørndal, Kristine, Høilund-Carlsen, Poul Flemming, Godballe, Christian
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Clinical Decision-Making
Disease Management
Female
Fluorodeoxyglucose F18
Head and neck neoplasms
Humans
Image Processing, Computer-Assisted
Interdisciplinary Communication
Male
MDTC
Middle Aged
Multimodal Imaging - methods
Neoplasm Recurrence, Local
Neoplasm Staging
Patient management
PET/CT
Positron Emission Tomography Computed Tomography - methods
Prospective Studies
Recurrence
Squamous Cell Carcinoma of Head and Neck - diagnostic imaging
Squamous Cell Carcinoma of Head and Neck - pathology
Squamous Cell Carcinoma of Head and Neck - therapy
Treatment plan
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Summary:•PET/CT changes management decisions in one-third of patients.•A greater share of patients is allocated to palliative treatment by PET/CT.•PET/CT may ensure successful management for more patients. To compare multidisciplinary team conference (MDTC) decisions regarding treatment intent based on either chest X-ray + MRI of the head and neck (CXR/MRI) or 18F-FDG-PET/CT (PET/CT) in patients with recurrent head and neck squamous cell carcinoma (HNSCC). Prospective blinded cohort study based on paired data. Consecutive patients with suspected recurrent HNSCC were invited to participate. All included patients underwent CXR/MRI and PET/CT before diagnostic biopsy. An ordinary MDTC using all available imaging data was conducted as per standard practice. After at least three months (to eliminate recall bias in the team), the first project MDTC, based on either CXR/MRI or PET/CT, was conducted, and the tumor board made conclusions regarding treatment. After an additional three months, a second project MDTC was conducted using the complementary imaging strategy. The separate treatment strategies were compared using McNemar’s test. A total of 110 patients (90 males and 20 females, median age 66 years, range 40–87) were included. The initial primary tumor originated from the pharynx in 56 (51%) patients, oral cavity in 17 (15%) patients, and larynx in 37 (34%) patients. Based on CXR/MRI, 87 patients (79%) were recommended curative treatment and 23 (21%) palliative treatment. Based on PET/CT, the MDTC decided that 52 (47%) patients were suitable for curative treatment and 58 (53%) for palliative treatment. The absolute difference of 32% was statistically significant (95% CI: 22–42%, p 
ISSN:1368-8375
1879-0593
DOI:10.1016/j.oraloncology.2019.04.025