Systematic review: Accuracy of imaging tests in the diagnosis of recurrent laryngeal carcinoma after radiotherapy (original) (raw)
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Improved detection of recurrent laryngeal tumor after radiotherapy using 18FDG-PET as initial method
Radiotherapy and Oncology, 2008
Background and purpose: Timely detection of recurrent laryngeal tumor after radiation is an important predictive factor for curation as well as preservation of laryngeal function. Direct laryngoscopy under general anesthesia with taking of biopsies is the standard diagnostic procedure to detect recurrence when suspicion is raised. This, however, is an invasive and potentially damaging technique. Hence, a non-invasive diagnostic procedure, such as 18 FDG-PET to stratify patients for direct laryngoscopy could be useful. 18 FDG-PET is interpreted visually so that observer variation may affect clinical practice. In the present study, we therefore investigated this aspect of reproducibility. Patients and methods: Thirty consecutive patients suspected of recurrent laryngeal carcinoma after radiotherapy underwent 18 FDG-PET and direct laryngoscopy under general anesthesia with taking of biopsies. 18 FDG-PET scans were reported by nine nuclear medicine physicians and residents, using a three-point scaling system. The reference was the absence or appearance of a local recurrence in the 12 months following 18 FDG-PET. Results: Eight patients had biopsy proven recurrent laryngeal carcinoma. Sensitivity of 18 FDG-PET was 88% (95% CI 53-98%) and specificity was 82% (95% CI 62-93%). The observers had a moderate to reasonable agreement (weighted kappa 0.45 (95% CI 0.20-0.69)) vs. the clinical gold standard and interobserver kappa was 0.54 (95% CI 0.40-0.69). Conclusion: 18 FDG-PET seems to be a promising technique to detect recurrent laryngeal carcinoma after radiotherapy, and selecting patients for direct laryngoscopy. This will avoid futile invasive procedures. Interobserver agreement and variability is reasonable using this technique, but training is necessary. Studies comparing different strategies to select patients for direct laryngoscopy in case of suspected recurrence are warranted.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2015
The purpose of this study is to evaluate the efficacy of (18)F-FDG-PET as first-line diagnostic investigation, prior to performing a direct laryngoscopy with biopsy under general anesthesia, in patients suspected of recurrent laryngeal carcinoma after radiotherapy. 150 patients suspected of recurrent T2-4 laryngeal carcinoma at least two months after prior (chemo)radiotherapy with curative intent for resectable disease were randomized to direct laryngoscopy (CWU: conventional workup strategy) or to (18)F-FDG-PET only followed by direct laryngoscopy if PET was assessed 'positive' or 'equivocal' (PWU: PET based workup strategy), to compare the effectiveness of these strategies. Primary endpoint was the number of indications for direct laryngoscopies classified as unnecessary based on absence of recurrence, both on direct laryngoscopy and on six month follow up. Safety endpoints comprised resectability of recurrent lesions and completeness of surgical margins following ...
World Journal of Nuclear Medicine, 2021
Posttreatment detection of residual/recurrence disease in the head and neck cancers is not an easy task. Treatment induces changes create difficulties in diagnosis on conventional imaging (computed tomography [CT], magnetic resonance imaging) as well as macroscopic inspection (direct laryngoscopy). Hence, we evaluate the diagnostic performance of contract-enhanced F-18 fluorodeoxyglucose positron emission tomography (FDG PET)/CT in restaging of laryngeal carcinoma Postchemotherapy-surgery and/or radiation therapy. We retrospectively analyzed patients of carcinoma larynx (n = 100) who has completed treatment and were referred for FDG PET/CT. Two reviewers performed image analysis to determine recurrence at primary site and/lymph nodes and distant metastases. Receiver operating characteristic (ROC) was used to determine the maximum standardized uptake value (SUVmax) cut off for disease detection. Histopathological examination and clinical or imaging follow-up were taken as gold standa...
Use of PET/CT to detect local and regional laryngeal cancer recurrence after surgery
Reports in Medical Imaging
Background: Laryngeal cancer is the second most common cancer of the head and neck after cancer of the oral cavity. The primary causes of death in cases of laryngeal cancer are the recurrence of locoregional disease and distant metastasis. Anatomic and tissue alterations resulting from surgery and/or radiotherapy of primary laryngeal tumors can make it difficult to determine a locoregional recurrence or residual disease by physical examination or computed tomography (CT)/magnetic resonance imaging (MRI). The majority of studies have shown a high accuracy in the detection of local and regional recurrence of head and neck cancer after different treatment modalities, using fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. Aim: To determine the diagnostic accuracy of PET/CT in patients with suspicion of locoregional recurrence from laryngeal carcinoma after surgery with or without adjuvant radiotherapy. Materials and methods: This was a retrospective study. Forty-five patients who previously underwent surgical treatment with or without adjuvant radiotherapy for primary laryngeal squamous cell carcinoma and who underwent examination using FDG-PET/CT imaging after clinical and instrumental (CT/MRI) suspicion of locoregional recurrence (T or N) were recruited. Results: Overall specificity, sensitivity, and accuracy of PET/CT were found to be 88%, 100%, and 93.3%, respectively. With respect to the suspected cases of recurrence in the primary site, sensitivity, specificity, and accuracy of PET/CT were found to be 100%, 87.5%, and 91.6%, respectively. In patients with suspected metastatic neck disease, PET/CT revealed a sensitivity, specificity, and accuracy of 100%, 90%, and 95.4%, respectively. Conclusion: According to the results of this study, PET/CT imaging in laryngeal tumors is a useful tool in case of suspected locoregional recurrence where conventional imaging (CT and MRI) is unable to resolve the diagnostic doubt.
Clinical Otolaryngology, 2018
18F FDG-PET is superior to other imaging techniques in revealing residual laryngeal cancer after radiotherapy. Unfortunately, its specificity is low, due to FDG uptake in inflammation and in anaerobic conditions. PET imaging with the amino acid-based radiopharmaceutical C11-methionine (MET) should be less influenced by post-radiation conditions. The aim of this study was to investigate the potential of MET in diagnosing recurrent laryngeal cancer after radiotherapy as compared to 18F-FDG. Methods: Forty-eight patients with a clinical suspicion of local residual disease at least 3 months after completion of radiotherapy or chemoradiotherapy for a T2-4 laryngeal carcinoma, along with an indication for direct laryngoscopy, were included. They received MET-PET and FDG-PET prior to the direct laryngoscopy. One senior nuclear medicine physician assessed both the FDG-PET and MET-PET images visually for the degree of abnormal uptake. The gold standard was a biopsy-proven recurrence 12 months after PET. The nuclear physician had no access to the medical charts and was blinded to the results of the other PET. Sensitivity, specificity and positive and negative predictive value were calculated. Results: The sensitivity of FDG was 77.3% and the specificity 56.0% after the conservative reading, with these values equalling 54.5% and 76.0% for MET. The positive predictive value of FDG was 60.7% and the negative predictive value 73.7%. The PPV of MET was 66.7%, and the NPV was 65.5%. The McNemar test within diseased (sensitivity comparison) shows a p-value of 0.125, and the McNemar test within non-diseased (specificity comparison) shows a P-value of 0.180. Conclusion: MET-PET is not superior to FDG-PET in terms of identifying recurrent laryngeal cancer. 1 | INTRODUCTION In the Netherlands, more than 80% of laryngeal cancers are primarily irradiated. Salvage surgery is performed in case of residual disease, but detection of residual or recurrent disease can be difficult after radiotherapy. In the first half year after radiotherapy, residual or recurrent disease especially can have a scattered and sub-mucosal
European Archives of Oto-Rhino-Laryngology, 2009
The aim of this study was to estimate the cost-eVectiveness of 18 FDG-PET in the selection for direct laryngoscopy in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. The direct medical costs of 30 patients with suspicion of a recurrence were calculated from the Wrst visit where suspicion was raised until one year after. A conventional strategy, in which all these patients underwent direct laryngoscopy, was compared to an 18 FDG-PET strategy in which only patients with a positive or equivocal 18 FDG-PET underwent direct laryngoscopy. A sensitivity analysis was performed to examine the inXuence of the type of camera and 'setting'. The mean costs of an 18 FDG-PET strategy were D399 less than a direct laryngoscopy strategy. The type of camera and setting had no inXuence. In patients with suspicion for recurrent laryngeal carcinoma after radiotherapy, 18 FDG-PET seems to be eVective and less costly in selecting patients for direct laryngoscopy.
Clinical Otolaryngology and Allied Sciences, 2001
Introduction. The objective was to improve the selectivity of photodynamic therapy (PDT) by targeting photosensitizers to tumours by the use of monoclonal antibodies (mAbs). Two sensitizers were selected for this approach. Meta-tetrahydroxyphenylchlorin (mTHPC) was selected because it is one of the most effective photosensitizers in free form. Aluminium (III) phthalocyanine tetrasulphonate [AlPc(SO 3 H) 4 ] was selected because of its ideal photochemical properties. However, owing to its hydrophilicity, this latter sensitizer is not able to enter the tumour cell and, therefore, in free form is ineffective in PDT. We hypothesized that AlPc(SO 3 H) 4 might become suitable for PDT when coupled to tumour-selective mAbs. Methods. These were developed to couple the sensitizers to mAbs, including mAb 425 directed against the epidermal growth factor receptor. These conjugates were evaluated for ef®cacy in PDT in vitro and for tumour-targeting capacity in vivo. Results. In vitro PDT showed that the AlPc(SO 3 H) 4 ±mAb 425 conjugate was %7500 times more toxic to A431 cells than the free sensitizer (IC 50 values 0.12 nm versus 900 nm), and was also more toxic than the mTHPC±mAb 425 conjugate and free mTHPC (IC 50 values 7.3 nm versus 2.0 nm). Biodistribution analysis of the conjugates in tumour-bearing nude mice showed selective accumulation in the tumour. Conclusion. These data show that AlPc(SO 3 H) 4 , in particular, has high potential for use in PDT when coupled to tumourselective mAbs.
BioMed Research International, 2014
Narrow band imaging is considered a significant improvement in the possibility of detecting early mucosal lesion of the upper aerodigestive tract. Early detection of mucosal neoplastic lesions is of utmost importance for patients survival. There is evidence that, especially in patients previously treated by means of curative radiotherapy or chemoradiotherapy, the early detection rate of recurrent disease is quite low. The aim of this study was to prove whether the videoendoscopy coupled with NBI might help detect recurrent or secondary tumors of the upper aerodigestive tract. 66 patients previously treated by means of RT or CRT with curative intent were enrolled in the study. All patients underwent transnasal flexible videoendoscopy with NBI mode under local anesthesia. When a suspicious lesion was identified in an ambulatory setting, its nature was proved histologically. Many of these changes were not identifiable by means of conventional white light (WL) endoscopy. The accuracy, sensitivity, specificity, and positive and negative predictive value of the method are very high (88%, 92%, 76%, 96%, and 91%, resp.). Results demonstrate that outpatient transnasal endoscopy with NBI is an excellent method for the follow-up of patients with carcinomas of the larynx and the hypopharynx primarily treated with radiotherapy.
C-11 methionine PET and 18-F FDG-PET for identifying recurrent laryngeal carcinoma
Chapter 1 General Introduction Chapter 2 Effectiveness of an 18F FDG-PET based strategy to optimize the diagnostic trajectory of suspected recurrent laryngeal carcinoma after radiotherapy: The RELAPS multicenter randomized trial Chapter 3 Recurrent Laryngeal Carcinoma Pet Study (Relaps): Cost Analysis Of 18F FDG-PET In Patients With Suspected Recurrent Laryngeal Cancer Previously Treated With Radiotherapy Chapter 4 Alternative PET tracers in head and neck cancer. A review Chapter 5 Visualization of small glottic laryngeal cancer using methyl-labeled 11C-Methionine Positron emission tomography Chapter 6 Is C-11 Methionine PET an alternative to 18F FDG-PET for identifying recurrent laryngeal cancer after radiotherapy?