Differential roles of18F-FDG PET in patients with locoregional advanced nasopharyngeal carcinoma after primary curative therapy: Response evaluation and impact on management

Sheng Chieh Chan, Tzu Chen Yen, Shu Hang Ng, Chien Yu Lin, Hung Ming Wang, Chun Ta Liao, Kang Hsing Fan, Joseph Tung Chieh Chang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

24 Scopus citations

Abstract

This prospective study compares the efficacies of whole-body 18F-FDG PET and a conventional work-up (CWU) in evaluating the treatment response for patients with locoregional advanced nasopharyngeal carcinoma (NPC) after primary curative therapy and investigates the impact of PET on patient management. Methods: Patients who had locoregional advanced NPC (stages III and IVa-b, staged by 18F-FDG PET and CWU) and who had completed primary curative therapy for 3 mo were enrolled. The curative therapy consisted of concurrent chemoradiotherapy with or without induction chemotherapy. All of the patients also underwent 18F-FDG PET and CWU to evaluate the response. The criteria for final diagnosis were based on pathology or subsequent follow-up for at least 6 mo. Rates of detection by 18F-FDG PET and CWU and the impact on management were determined on site and patient bases, respectively. Results: From January 2002 to August 2005, 131 patients with NPC were eligible, including 71 patients with stage III NPC (group A) and 60 patients with stage IVa-b NPC (group B). Twelve patients were proven to have residual tumors. 18F-FDG PET had a higher overall sensitivity than CWU in group A (100% vs. 25%) and group B (91.7% vs. 58.3%). The overall specificity of PET was significantly higher than that of CWU in group B (97.6% vs. 91.7%; P = 0.019) but was slightly lower in group A (95.7% vs. 96.7%). The overall accuracy of PET also was significantly higher than that of CWU in group B (97.2% vs. 89.4%; P = 0.002) but was similar to that of CWU in group A (95.8% vs. 95.3%). PET resulted in management changes in 11 patients (15.4%; 11/71) in group A, with positive and negative impacts on 3 and 8 patients, respectively. In group B, the management of 26 of 60 patients (43%) was changed as a result of PET and included positive impacts on 23 patients and negative impacts on 3 patients. Conclusion: 18F-FDG PET plays differential roles in patientswith stage III NPC and stage IVa-b NPC after primary curative therapy. PET has higher sensitivity and specificity in evaluating the response and results in bettermanagement of patients with stage IVa-b NPC. PET has a less prominent impact on patient management but higher sensitivity in patients with stage III NPC.

Original languageEnglish
Pages (from-to)1447-1454
Number of pages8
JournalJournal of Nuclear Medicine
Volume47
Issue number9
StatePublished - 01 09 2006

Keywords

  • Clinical impact
  • F-FDG PET
  • Nasopharyngeal carcinoma
  • Residual tumor
  • Response evaluation

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