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  • [J Clin Oncol.] Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography After Concurrent Chemoradiotherapy in Locally Advanced Head-and-Neck Squamous Cell Cancer: The ECLYPS Study.

    University Hospital Antwerp / Tim Van den Wyngaert*

  • 출처
    J Clin Oncol.
  • 등재일
    2017 Oct 20
  • 저널이슈번호
    35(30):3458-3464.
  • 내용

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    Abstract


    Purpose

     

    To assess the standardized implementation and reporting of surveillance [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan of the neck in locoregionally advanced head-and-neck squamous cell carcinoma (LAHNSCC) after concurrent chemoradiotherapy (CCRT). 

     

    Patients and Methods 

    We performed a prospective multicenter study of FDG-PET/CT scanning 12 weeks after CCRT in newly diagnosed patients with LAHNSCC (stage IVa/b) that used standardized reconstruction and Hopkins reporting criteria. The reference standard was histology or > 12 months of clinical follow-up. The primary outcome measure was the negative predictive value (NPV) of FDG-PET/CT scans and other supporting diagnostic test characteristics, including time dependency with increasing follow-up time. 

     

    Results 

    Of 152 patients, 125 had adequate primary tumor control after CCRT and entered follow-up (median, 20.4 months). Twenty-three (18.4%) had residual neck disease. Overall, NPV was 92.1% (95% CI, 86.9% to 95.3%; null hypothesis: NPV = 85%; P = .012) with sensitivity of 65.2% (95% CI, 44.9% to 81.2%), specificity of 91.2% (95% CI, 84.1% to 95.3%), positive predictive value of 62.5% (95% CI, 45.5% to 76.9%), and accuracy of 86.4% (95% CI, 79.3% to 91.3%). Sensitivity was time dependent and high for residual disease manifesting up to 9 months after imaging but lower (59.7%) for disease detected up to 12 months after imaging. Standardized reporting criteria reduced the number of equivocal reports (95% CI for the difference, 2.6% to 15.0%; P = .003). Test characteristics were not improved with the addition of lymph node CT morphology criteria. 

     

    Conclusion 

    FDG-PET/CT surveillance using Hopkins criteria 12 weeks after CCRT is reliable in LAHNSCC except for late manifesting residual disease, which may require an additional surveillance scan at 1 year after CCRT to be detected.

     

    Author information

    Van den Wyngaert T1, Helsen N1, Carp L1, Hakim S1, Martens MJ1, Hutsebaut I1, Debruyne PR1, Maes ALM1, van Dinther J1, Van Laer CG1, Hoekstra OS1, De Bree R1, Meersschout SAE1, Lenssen O1, Vermorken JB1, Van den Weyngaert D1, Stroobants S1; ECLYPS investigators.

    Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom. 

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