PET – Oral Cancer News

Two markers help predict head and neck cancer prognosis

Source: labblog.uofmhealth.org Author: news release, University of Michigan Health Rogel Cancer Center A new study from the University of Michigan Health Rogel Cancer Center finds circulating tumor DNA, or ctDNA, levels can predict as early as two weeks after starting treatment which patients are likely to have good outcomes. At the same time, specialized MRI and PET scans two weeks after starting chemoradiation also correlated with outcomes. “Rates of throat cancer have steadily increased in recent years, driven by HPV infections, fueling the need for biomarkers to help guide treatment decisions, especially for locally advanced disease,” said senior study author J. Chad Brenner, Ph.D., associate professor of otolaryngology at Michigan Medicine. “Quantitative imaging of metabolism, local blood volume density and cell density from PET and MRI scans have shown both prognostic value in predicting treatment outcome as well as utility in selecting patients for additional focal radiation treatment,” said study author Yue Cao, Ph.D., professor of radiation oncology and radiology at Michigan Medicine. The researchers conducted a randomized trial of patients with stage 3 oropharyngeal squamous cell carcinoma. In total, 93 patients had imaging and 34 also had blood tests before starting chemoradiation and again at two, four and seven weeks after treatment. The study found that HPV ctDNA clearance at two weeks, but not at four weeks, predicted outcomes. The metabolism, local blood density and cell density before radiation therapy or at two weeks after starting treatment predicted outcomes as well. These early predictor biomarkers could help determine which [...]

Oral Cancer Foundation News Team - A2021-11-17T07:43:52-07:00November, 2021|Oral Cancer News|

Nonsurgical surveillance safe, cost-effective for head, neck cancer

Source: www.healio.com Author: Mehanna H, et al. Patients with head and neck cancer who underwent PET/CT–guided surveillance achieved similar survival outcomes as those who underwent planned neck dissections, according to the results of a prospective, randomized controlled trial. However, surveillance led to fewer surgical operations and complications and appeared more cost-effective than neck dissection, results showed. Patients with head and neck cancer frequently undergo invasive surgery following treatment to remove remaining cancer cells, according to study background. “After treatment, remaining cancer cells play something akin to hide and seek,” Hisham Mehanna, MBChB, PhD, FRCS, chair of head and neck surgery at University of Birmingham and director of the Institute of Head and Neck Studies and Education, said in a press release. “Our study shows that we can hunt them down, find them and remove them effectively.” Mehanna and colleagues sought to define the role of image-guided surveillance compared with planned neck dissection for the management of patients with advanced, nodal head and neck squamous cell carcinoma previously treated with primary chemoradiotherapy. The analysis included data from 564 patients (mean age, 58 years; 82% men) who researchers randomly assigned to PET/CT–guided surveillance (n = 282) performed 12 weeks after the end of treatment or planned neck dissection (n = 282). Oropharyngeal cancer served as the most common cancer subtype (84%). Seventy-five percent of patients had HPV-16–positive disease. Patients assigned surveillance only underwent neck dissection if their PET/CT scans showed incomplete or equivocal response to chemoradiotherapy. The trial was designed to assess [...]

Oral Cancer Foundation News Team - A2016-03-24T09:07:04-07:00March, 2016|Oral Cancer News|

Imaging technique identifies early metastasis in lymph nodes

Source: www.newswise.com Author: National Institute of Biomedical Imaging and Bioengineering NIBIB-funded researchers have developed a highly sensitive and accurate imaging technique for non-invasive screening of lymph nodes for metastatic cancer. Current practice calls for invasive surgical biopsies to determine whether deadly metastatic cancer cells have invaded the lymph nodes. The new imaging technique – so far tested in mice – offers a rapid and effective tool to noninvasively identify very small numbers of these cells, known as micrometastases, thus detecting cancer’s spread at its earliest stages, which is critical for timely treatment. The work, developed at the University of Texas at Austin and the University of Texas MD Anderson Cancer Center, is reported in the October issue of Cancer Research. The technique uses an imaging approach known as ultrasound-guided photoacoustics combined with nanosensors designed to target and identify metastatic cells in lymph nodes. Richard Conroy, Ph.D., Director of the NIBIB Program in Molecular Imaging elaborates on the technology’s potential: "This work is an excellent example of the development of a cutting edge technology that works very well in an experimental system but also has great potential to change the way we monitor and diagnose cancer metastasis. Identifying the accumulation of cells early in the process with some molecular characterization offers the opportunity for more targeted and effective treatment and fewer side effects.” More than 90% of cancer deaths can be attributed to metastases either directly or indirectly. In current clinical practice, an invasive surgical procedure called sentinel lymph node (SLN) [...]

Oral Cancer Foundation News Team - A2015-05-24T08:48:05-07:00May, 2015|Oral Cancer News|

PET may artificially boost HNC survival rates

Source: www.drbicuspid.com Author: Donna Domino, Features Editor The use of positron emission tomography (PET) is associated with a stage migration phenomenon in locally advanced head and neck cancer (HNC) patients, according to a recent report in JAMA Otolaryngology -- Head & Neck Surgery. Multiple studies have shown the increased sensitivity of fluorodeoxyglucose (FDG)-PET over computed tomography (CT) for detecting primary tumors, regional nodal disease, and distant metastases. Because of potential treatment changes and prognostic information, as well as patient and physician preference, FDG-PET has been rapidly adopted for managing head and neck cancers. Because FDG-PET is more sensitive than CT, it often leads to patients being assigned a higher stage than if they were staged with CT alone, the study authors noted. In this retrospective study, the researchers sought to confirm whether the increased use of FDG-PET over time is associated with the appearance of improved stage-specific survival due to stage migration (JAMA Otolaryngol Head Neck Surg, July 1, 2014, Vol. 140:7, pp. 654-661). Results In the study's model of clinically important variables, PET scan use was associated with a higher stage of disease. In addition, oropharyngeal cancers were more likely to be assigned a higher stage than oral cavity cancers. Within the PET era, no statistically significant survival difference was found between those who underwent FDG-PET and those who did not. However, a significant increase in stage-specific survival was detected for patients with locally advanced disease. No stage-specific survival differences were found in patients with local disease or metastatic [...]

Oral Cancer Foundation News Team - A2014-08-12T08:29:46-07:00August, 2014|Oral Cancer News|

The lack of evidence for PET or PET/CT surveillance of patients with treated lymphoma, colorectal cancer, and head and neck cancer: a systematic review

Source: jnm.snmjournals.org Authors: Kamal Patel et al PET and PET/CT are widely used for surveillance of patients after cancer treatments. We conducted a systematic review to assess the diagnostic accuracy and clinical impact of PET and PET/CT used for surveillance in several cancers. Methods: We searched MEDLINE and Cochrane Library databases from 1996 to March 2012 for English-language studies of PET or PET/CT used for surveillance of patients with lymphoma, colorectal cancer, or head and neck cancer. We included prospective or retrospective studies that reported test accuracy and comparative studies that assessed clinical impact. Results: Twelve studies met our inclusion criteria: 6 lymphoma (n = 767 patients), 2 colorectal cancer (n = 96), and 4 head and neck cancer (n = 194). All studies lacked a uniform definition of surveillance and scan protocols. Half the studies were retrospective, and a third were rated as low quality. The majority reported sensitivities and specificities in the range of 90%–100%, although several studies reported lower results. The only randomized controlled trial, a colorectal cancer study with 65 patients in the surveillance arm, reported earlier detection of recurrences with PET and suggested improved clinical outcomes. Conclusion: There is insufficient evidence to draw conclusions on the clinical impact of PET or PET/CT surveillance for these cancers. The lack of standard definitions for surveillance, heterogeneous scanning protocols, and inconsistencies in reporting test accuracy preclude making an informed judgment on the value of PET for this potential indication. Authors: Kamal Patel, Nira Hadar, Jounghee Lee, Barry A. [...]

Oral Cancer Foundation News Team - A2013-09-04T07:09:32-07:00September, 2013|Oral Cancer News|

Timing of Post-TX Imaging Key in Head, Neck Cancer

Source: MedScape Today Summary The investigators report on a systematic review and meta-analysis of 51 studies involving 2335 patients with head and neck squamous cell carcinoma who underwent post-treatment or surveillance with 18F-fluorodeoxyglucose (FDG) PET or FDG-PET/CT. The random-effects model-weighted mean pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of residual disease at the primary tumor site were 79.9% (95% CI, 73.7%-85.2%), 87.5% (95% CI, 85.2%-89.5%), 58.6% (95% CI, 52.6%-64.5%), and 95.1% (95% CI, 93.5%-96.5%), respectively. The respective values for detection of residual post-treatment neck nodes were 72.7% (95% CI, 66.6%-78.2%), 87.6% (95% CI, 85.7%-89.3%), 52.1% (95% CI, 46.6%-57.6%), and 94.5% (95% CI, 93.1%-95.7%). In a subgroup analysis on timing of PET after completion of therapy, scans performed after 12 weeks had significantly higher diagnostic performance than scans done within 12 weeks, but only for residual neck nodes and not for residual disease at the primary tumor site. No statistically significant difference in diagnostic accuracy was noted between stand-alone PET and PET/CT. Viewpoint Well-performed systematic reviews and meta-analyses are important contributions to the literature.[1] In this meta-analysis, the diagnostic performance of dedicated PET and PET/CT with FDG was investigated by pooling the data from a relatively large cohort of patients with head and neck cancer who had been treated with chemoradiation. The pooled evidence demonstrated good diagnostic performance for FDG-PET and FDG-PET/CT, regardless of the type of scanner, with very high NPV but somewhat suboptimal PPV; this is due to the nonspecificity of FDG, [...]

Charlotte Parker2012-02-22T09:47:08-07:00February, 2012|Oral Cancer News|

IMRT provides better QOL in head and neck cancers

Source: www.oncologyreport.com/ AUthor: Miriam E. Tucker Intensity-modulated radiotherapy is more expensive than 3-D–conformal radiotherapy is and has not been shown to improve standard outcomes in patients with head and neck cancer. But it results in better quality of life. These findings from two studies presented at the Multidisciplinary Head and Neck Cancer Symposium raise the question: Does improved quality of life justify the greater expense of intensity modulated radiotherapy (IMRT), which has been rapidly adopted for the treatment of head and neck cancer? Because IMRT spares surrounding tissues, it reduces the likelihood of developing xerostomia, noted Dr. Nathan C. Sheets, who presented data on billing charges associated with IMRT, compared with 3-D–conformal radiotherapy (CRT). IMRT is reimbursed at a substantially higher level than CRT, however, and it is unclear how to assess this cost relative to other aspects of care in this population, said Dr. Sheets, a radiation oncology resident at the University of North Carolina, Chapel Hill. A separate study presented by Dr. Allen M. Chen compared quality of life in patients who received IMRT vs. CRT. "There’s very little data to suggest IMRT is better than non-IMRT using traditional end points. But the question is: How do you define ‘better’?" said Dr. Chen, director of the radiation oncology residency training program at the University of California, Davis in Sacramento. "IMRT might not particularly involve better cure rates, but it could make a difference in terms of other end points, such as quality of life, which we all know [...]

Oral Cancer Foundation News Team - A2012-02-12T09:20:40-07:00February, 2012|Oral Cancer News|

FDG-PET staging and importance of lymph node SUV in head and neck cancer

Source: 7thspace.com Author: staff Objectives: The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC. Methods: Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on to receive radiotherapy. Results: The median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p <0.0007). Maximum SUV for the primary tumor >8.0 was predictive of worse overall survival (p <0.045), while the SUV of the lymph nodes was predictive for distant recurrence at one year--with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p <0.05). Conclusions: FDG-PET staging in head and neck cancer has good positive and negative predictive values in determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the first report to find that the SUV of a lymph node is predictive for ECE [...]

Oral Cancer Foundation News Team - A2010-07-18T06:52:58-07:00July, 2010|Oral Cancer News|

Molecular imaging allows individualized ‘dose painting’ for head and neck cancers

Source: www.eurekalert.org Author: public release According to research revealed at Society of Nuclear Medecine's 57th Annual Meeting, a multi-tracer molecular imaging technique using positron emission tomography (PET) provides detailed information about the physiological processes of cancerous tumors—and could one day help radiation oncologists treat head and neck cancers with precision external-beam radiation therapy and improve the outcomes of therapy. "The research that we are conducting with Philips is extending the use of molecular imaging for radiotherapy planning, moving closer to more personalized treatment of hard-to-treat cancers based on the biology of each individual patient's tumor," said Kristi Hendrickson, Ph.D., lead author of the study and medical physicist at the University of Washington Medical Center, Seattle, Wash. "By modeling the data acquired from PET scans, we can potentially reduce damage to surrounding healthy tissue, as well as provide the ability to do 'dose painting,' delivering a highly customized form of radiation therapy for each patient." Cancers of the head and neck are notoriously difficult to treat, not only because of their proximity to sensitive anatomical structures, but also because of their tendency to recur. Researchers are working to find the best way to image these tumors in order to provide the most effective treatment. Several forms of radiation therapy are currently available. An approach called intensity modulated radiation therapy (IMRT) is a sophisticated technique which is used to maximize dose delivery to tumors while sparing adjacent normal tissues such as the salivary glands. This therapy uses an external beam of radiation [...]

Oral Cancer Foundation News Team - A2010-06-07T15:05:46-07:00June, 2010|Oral Cancer News|

Journal of Nuclear Medicine: Costs for PET, PET/CT decreasing with increase in oncologic exams

Source: www.healthimaging.com Author: staff An article published in the March issue of the Journal of Nuclear Medicine reports on the methodologies for conducting economic evaluations of PET and PET/CT in oncologic applications, suggesting that PET and PET/CT are cost effective for staging of non–small cell lung cancer, differential diagnosis of solitary pulmonary nodules, restaging of Hodgkin's disease and non-Hodgkin's lymphoma and the restaging of colorectal carcinoma. Healthcare systems globally have recently approved reimbursement for PET and PET/CT for staging of non-small cell lung cancer and differential diagnosis of solitary pulmonary nodules because PET and PET/CT have been found to be cost-effective for those uses, according to Andreas K. Buck, MD from Nuklearmedizinische Klinik und Poliklinik in München, Germany, and colleagues. Additional indications that are covered by healthcare systems in the U.S. and several European countries include staging of gastrointestinal tract cancers, breast cancer, malignant lymphoma, melanoma, and head and neck cancers, added Buck and colleagues. PET and PET/CT are highly sensitive diagnostic tests to screen for metastatic tumor deposits in the entire body that may be missed by standard imaging modalities. On a patient basis, costs for PET and PET/CT are decreasing with the increasing numbers of examinations performed, noted Buck and colleagues. In Germany, “costs per examination range between approximately € 600 ($885 U.S.) and €1,000 ($1,474 U.S.); the amount for production and delivery of radiopharmaceuticals is approximately €180–€ 260 ($265–$383 U.S.) per scan.” In Great Britain, costs range from £635–£1,300 ($1,030– $2,109 U.S.) for PET. In Europe, reimbursement [...]

Oral Cancer Foundation News Team - A2010-04-01T19:59:52-07:00April, 2010|Oral Cancer News|