頭頸部癌の臨床におけるFDG-PETの有用性

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Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used in evaluating head and neck cancer. Here we describe its utility in staging and restaging of head and neck cancer, especially when treated by concurrent chemoradiotherapy (CCRT). Of patients with hypopharyngeal cancer treated by CCRT, those with a high FDG-uptake at primary site on posttreatment restaging PET showed significantly poorer local control and cause-specific survival than those with a low FDG-uptake. In contrast, neither local control nor cause-specific survival differed significantly between the patients with a high FDG-uptake and those with a low FDG-uptake on pretreatment baseline PET. High FDG-uptake on restaging PET but not on baseline PET served as an adverse prognostic factor for patients with oropharyngeal cancer treated by CCRT. Restaging PET less well identified persistent nodal disease in patients with node-positive head and neck cancer treated by CCRT, as compared to restaging CT. Baseline PET served to detect synchronous second primary cancer, especially of the colon, but not of the esophagus and stomach at early stage. We conclude that post-CCRT restaging PET serves to identify a subset of patients potentially benefiting from adjuvant therapy, and that restaging CT, not restaging PET, serves to identify a subset of patients at a high risk of persistent nodal disease requiring planned neck dissection. Lugol chromoendoscopy, which is very sensitive for detecting synchronous upper gastrointestinal tract cancer, should be included in work-up of head and neck cancer patients, together with baseline PET.
耳鼻咽喉科臨床学会の論文

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猪原秀典
大阪大学大学院耳鼻咽喉科・頭頸部外科学

頭頸部癌の臨床におけるFDG-PETの有用性

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