Fluorodeoxyglucose Positron Emission Tomography for the Preoperative Staging of Oral Cavity Cancers: Only One Piece of the Puzzle
9/19/2006 Toronto, Ontario, Canada Editorial - John N. Waldron Journal of Clinical Oncology, Vol 24, No 27 (September 20), 2006: pp. 4367-4368 At present, the potential uses for positron emission tomography (PET) in the management of cancer include the characterization of disease at presentation, assessment of disease response to treatment, and the detection of recurrent disease. Published reports of the use of PET in cancer patients listed in the PubMed database have multiplied by a factor of 10 over the last decade, with close to 1,000 reports in 2005. It is reasonable to conclude that, for the majority of patients at presentation who undergo staging with computed tomography (CT) and/or magnetic resonance imaging (MRI), the use of fluorodeoxyglucose (FDG) PET does not add information that would change initial management. Nonetheless, FDG-PET will detect disease that would have been otherwise overlooked for an important minority of patients. The consequence should prevent undertreatment in the case of specifically targeted therapies such as surgery or radiation. Alternatively, when FDG-PET determines that disease has spread beyond the possibility of curative treatments, the morbidity of overtreatment will be avoided. A greater potential impact of FDG-PET is its putative ability to exclude disease, thereby avoiding the need for further investigation or more extensive local or systemic treatment. Examples of this potential could be the avoidance of axillary dissection and cytotoxic chemotherapy in breast cancer patients with a PET-negative axilla, the avoidance of mediastinoscopy for lung cancer patients with a PET-negative mediastinum, and, in many cancer sites [...]