Misako Nagasaka,
Fellow Student at Wayne State University School of Medicine
Title: Can PET scans post chemoradiation in head and neck squamous cell cancer (HNSCC) spare patients of unnecessary salvage surgery?
Biography
Biography: Misako Nagasaka,
Abstract
The treatment of residual disease post definitive chemoradiation in HNSCC often involves extensive salvage surgery. PET scans post treatment may help differentiate between viable tumor and treatment effects and there has been increased debate on this topic.
Methods and Results: Case presentation a review of the literature.
Case: A 58 year old man with stage IVa (T4a N0 M0) SCC of the right base of tongue, p16 positive, was treated with definitive chemoradiation utilizing cisplatin 100mg/m2 every 3 weeks and a total of 70Gy of radiation. His initial MRI findings 12 weeks post chemoradiation showed a bulky enhancement at the base of tongue, 1.2 x 1.9 x 1.2 cm in size, worrisome for possible residual disease. A repeat MRI done at 20 weeks did not show improvement. He therefore had a PET scan at 25 weeks. The PET scan did not show any FDG uptake. He was therefore continued on surveillance with clinic visits, serial imagings with neck MRIs as well as nasopharyngolaryngoscopies. He continues to do well without evidence of disease 17 months post completion of chemoradiation and has successfully been spared of salvage surgery.
Discussion: PET scans in patients with HNSCC who have received chemoradiotherapy have shown high negative predictive values of 96%. There are also emerging data from observations reporting that HPV positive tumors may take more time to involute post therapy.
Conclusion: PET scans may have a role in identifying those who could be safely followed post definitive therapy even with residual findings on MRIs.