Interim 18FDG PET/CT during chemo-radiotherapy in the management of head-neck cancer patients: a systematic review

Publication date: Available online 4 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Cristina Garibaldi, Sara Ronchi, Marta Cremonesi, Laura Gilardi, Laura Travaini, Mahila Ferrari, Daniela Alterio, Johannes H.A.M. Kaanders, Delia Ciardo, Roberto Orecchia, Barbara Alicja Jereczek-Fossa, Chiara Maria Grana
Positron-Emission-Tomography (PET) is an imaging modality widely applied in oncology for tumor staging, volume delineation in radiotherapy planning, and therapy response assessment. ¹⁸F-fluorodeoxyglucose PET combined with Computed Tomography (¹⁸F-FDG-PET/CT) plays a significant role in the management of locally advanced head-neck cancer patients in the pre-treatment setting to predict outcome and prognosis and after chemo-radiotherapy (CRT) to assess tumor response. This review aims to evaluate the use of FDG-PET acquired during CRT, ad interim FDG (FDGint), in order to identify tumor response at an early stage, modify the treatment plan if necessary or setup alternative strategies to enhance the therapeutic ratio. Most of the works confirmed the value of FDGint in predicting the response to CRT, while a few highlighted the poor predictive value of FDGint compared to FDG acquired two-four months after the end of CRT, which was well correlated with local and regional control and survival. Such findings deserve to be further analyzed in a more numerous and homogeneous series according to the tumor site and CRT schedules. The best time to assess tumor response during RT remains a matter of debate, although two weeks seem most favorable, still providing opportunity to adapt the treatment strategy.



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