Head and Neck Cancer
Head and Neck Cancer
复制标题
DOI：
10.1007/978-0-387-48894-3_10
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
H. Schöder
中科院分区：
文献类型：
--
作者：
H. Schöder
大多数头颈癌是发生在口腔、口咽部、喉部和下咽部的鳞状细胞癌。在工业化国家，HNSCC的发病率正在上升，人们越来越认识到人类乳头瘤病毒(HPV)感染在这种疾病发展中的病因学因素。在美国，2011年新确诊的头颈癌病例约为49,260例，约11,480名患者死于这种疾病。CT或MRI对于确定原发肿瘤的范围、评估淋巴结大小以及检测骨骼和骨髓疾病是必不可少的。[18F]从颅底到骨盆底的FDG PET/CT成像对于局部晚期疾病患者和所有接受明确的放化疗以确定N和M分期的患者来说是必不可少的。解释头颈部PET/CT需要在头颈部解剖学方面的专业知识，并了解正常组织中生理性的[18F]FDG摄取的变化。扫描解释主要基于目测评估，尽管SUV测量可能会有所帮助。然而，SUV与病变大小有关，在小的原发肿瘤中可能被低估。大多数原发肿瘤起源于腭扁桃体、舌根、梨状窝、鼻咽和喉部。HNSCC倾向于局部扩散，侵犯邻近结构。T分期通常由CT或MRI完成，而不是PET。然而，有时[18F]FDG PET可能会显示出小的粘膜下原发肿瘤，这些肿瘤很难通过解剖成像研究与邻近的正常组织区分开来。淋巴结转移的存在是头颈癌患者生存的独立预后因素，并可能影响手术或放射治疗的选择。早期彻底切除颈淋巴结转移是治愈的先决条件。PET在初始节点阶段提供了附加值。然而，假阳性的[18F]FDG摄取可发生在炎症的、反应性的淋巴结中。假阴性的[18F]FDG PET研究可能发生在肿瘤负荷小、转移结节囊性变性并有一小圈存活的肿瘤组织、或转移结节的示踪剂摄取率低时。当原发灶显示非常强烈的示踪剂摄取时，靠近原发灶的结节转移可能不能作为单独的高代谢灶被检测到。远处转移在头颈部癌症患者中很少见，但随着T分期和大小、肿瘤累及淋巴结的数量、颈静脉受侵以及下咽和口咽部原发肿瘤的增加，远处转移的频率也会增加。最常见的部位是肺，其次是骨头和肝脏。[18F]FDG PET/CT是检测远处转移的灵敏方法。在接受明确的放化疗的患者中，[18F]FDG PET/CT应该在结束治疗后大约12周进行，以评估治疗反应。[18F]FDG PET/CT成像对于检测颈部淋巴结内残留病变特别有用。临床参数和结构成像不能可靠地预测颈部残留转移疾病的存在；过去通常在化疗结束后进行计划颈清扫术，特别是在最初患有N2-N3疾病的患者中。最近，鉴于治疗后[18F]FDG PET的高度阴性预测价值，这种方法似乎不再合理。在疑似复发的患者中，无论采用何种治疗方法，[18F]FDG PET/CT都具有最高的敏感性和特异性。然而，治疗后的炎症仍然是假阳性解释的潜在来源。…的癌症
Most head and neck cancers are squamous cell carcinomas (HNSCC) arising in the oral cavity, oropharynx, larynx, and hypopharynx. The incidence of HNSCC is rising in the industrialized world, and there is increasing recognition of the role of human papillomavirus (HPV) infection as an etiologic factor in the development of this disease. In the USA, about 49,260 new cases of head and neck cancer have been diagnosed in 2011, and approximately 11,480 patients died of the disease. CT or MRI is essential to define the extent of the primary tumor, assess lymph node size, and detect bone and bone marrow disease. [18F]FDG PET/CT imaging from the skull base to the floor of the pelvis is essential in patients with locally advanced disease and in all patients who are candidates for definitive chemoradiotherapy to define N and M staging. Interpretation of head and neck PET/CT requires expertise in head and neck anatomy and an understanding of variations of physiologic [18F]FDG uptake in normal tissues. Scan interpretation is primarily based on visual assessment, although SUV measurements may be helpful. However, SUV is related to lesion size and may be underestimated in small primary tumors. Most primary tumors originate in the palatine tonsil, base of tongue, pyriform sinus, nasopharynx, and larynx. HNSCC tends to spread locally with invasion of adjacent structures. T staging is routinely done by either CT or MRI, not PET. However, occasionally [18F]FDG PET may visualize small submucosal primary tumors that are difficult to distinguish from adjacent normal tissues with anatomic imaging studies. The presence of nodal metastases is an independent prognostic factor for survival in patients with head and neck cancer and may affect the choice of surgical or radiation therapy. Early and complete removal of neck node metastases is a prerequisite for cure. PET provides added value in the initial nodal staging. However, false-positive [18F]FDG uptake can occur in inflamed, reactive lymph nodes. False-negative [18F]FDG PET studies may occur when nodes have a small tumor burden, cystic degeneration of metastatic nodes with a small rim of viable tumor tissue, or low tracer uptake in the metastatic node. Nodal metastases in close proximity to the primary tumor may not be detectable as separate hypermetabolic focus when the primary shows very intense tracer uptake. Distant metastases are rare in patients with head and neck cancers, but the frequency increases with higher T stage and size, number of tumor-involved lymph nodes, jugular vein invasion, and in primary tumors in the hypo- and oropharynx. The most common location is the lung, followed by bone and liver. [18F]FDG PET/CT is sensitive for the detection of distant metastases. In patients treated with definitive chemoradiotherapy, [18F]FDG PET/CT should be done approximately 12 weeks after the end therapy to assess response to treatment. [18F]FDG PET/CT imaging is particularly useful to detect residual disease in neck lymph nodes. Clinical parameters and structural imaging cannot reliably predict the presence of residual metastatic neck disease; “planned neck dissection” was usually performed in the past after the completion of chemoradiotherapy, especially in patients with initial N2–N3 disease. Recently, in light of the high negative predictive value of posttreatment [18F]FDG PET, this approach seems no longer justified. In patients with suspected recurrence, [18F]FDG PET/CT has the highest sensitivity and specificity regardless of the primary treatment modality. However, posttherapy inflammation remains a potential source for false-positive interpretation.Carcinoma of…