The Role of positron emission tomography and computed tomography fusion in the management of early-stage and advanced-stage primary head and neck squamous cell carcinoma

Objective: To evaluate the role of positron emission tomography and computed tomography (PET-CT) fusion in the management of early-stage and advanced-stage primary head and neck squamous cell cancer. Design: Retrospective analysis, with a blinded evaluation of clinical data and formation of a treatment plan. Setting: Single tertiary academic medical institution. Patients: Thirty-six patients with previously untreated head and neck squamous cell carcinoma who underwent staging CT or magnetic resonance imaging of the neck prior to undergoing PET-CT as part of their initial diagnostic evaluation between July 2000 and January 2005. Main Outcome Measures: Confirmation or alteration of the treatment plan with the addition of the PET-CT information compared with traditional clinical and radiological data alone for early-stage and advanced-stage disease. When available, histopathological results were correlated with the PET-CT findings. Results: Among the 36 patients, PET-CT provided additional information that confirmed the treatment plan in 25 patients (69%) and altered the treatment plan in 11 patients (31%). Six of 11 patients in the altered-treatment group had their tumors upstaged. Four of 8 patients with early-stage tumors had their treatment plan altered, compared with 7 of 28 patients with advanced-stage disease. Among 18 patients who underwent a surgical intervention for their primary tumor, PET-CT identified the primary tumor in all 18 patients and, based on histopathological findings, correctly staged the regional nodal disease in 9 of 16 patients who had their nodal disease addressed. Conclusion: The use of PET-CT is important in the initial treatment planning of early-stage and advanced-stage head and neck squamous cell carcinoma.