FDG-PET to evaluate intraarterial chemoradiotherapy as organ preservation protocol in oral squamous cell carcinoma

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Recently, neoadiuvant chemoradiotherapy as an organ-preserving protocol has shown good clinical response in patients with oral cancer. Accurate evaluation of therapeutic effect is essential to determine further operation after the chemoradiotherapy in consideration of the patients prognosis and quality of life. The aim of this study was to evaluate the possible usefulness of positron emission tomography with 18F labeled fluorodeoxyglucose (FDG-PET) for predicting response to intraarterial chemoradiotherapy (THP-ADM+5-FU+carboplatin), and prognosis in oral carcinomas.Materials and Methods : Thirty-five patients with oral squamous cell carcinoma (SCC) were included in the study. All patients completed the treatment regimen, and each patient underwent 2 FDG-PET studies, one prior to and one at 4 weeks after the chemoradiotherapy. The pre-and post-treatment PET images were compared with clinical and histopathological evaluations of the treatment effect. For the quantitative evaluation of r … More egional radioactivity, standardized uptake values (SUVs) were used.Results : The chemoradiotherapy demonstrated good clinical response (Overall clinical response rate 100% ; CR rate 71%) and histological response (p-CR rate 83%). All neoplastic lesions showed high SUVs (mean, 10.00mg/ml) prior to the treatment, which values significantly decreased after the therapy (3.74mg/ml, p<0.01). Change in FDG uptake paralleled the treatment effect. Lesions with higher pre-SUVs (_7 mg/mL) showed residual viable tumor cells after the treatment in 6 out of 25 patients, and 3-year survival rate of 79%. whereas those with lower SUVs (<7mg/mL, 10 patients) were successfully treated, and showed significantly higher 3-year survival (100%). Six out of 13 tumors with post-SUVs _4 mg/ml had viable tumor cells, whereas all (22/22) tumors with post-SUVs <4 mg/mL showed no viable cells. Based on PET results, 10 patients avoided operation altogether, and 19 patients underwent a reduced form of surgery. Each patient showed no local recurrence within 5-year follow-up.Conclusions : Concomitant chemoradiotherapy is effective for head and neck carcinoma. Pretreatment FDG-PET is useful in predicting the response to treatment and prognosis. Posttreatment FDG-PET can evaluate residual viable cells. Organ preservation may be feasible based on PET evaluation. Hence FDG-PET is a valuable tool in the treatment of oral cancer. Less