Evidence map›Paper›PMID 31485835›Full record

ArticleEuropean radiology2020

Second-look PET-CT following an initial incomplete PET-CT response to (chemo)radiotherapy for head and neck squamous cell carcinoma.

Robin J D Prestwich, Moses Arunsingh, Jim Zhong, Karen E Dyker, Sriram Vaidyanathan, Andrew F Scarsbrook

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Article in European radiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Robin J D PrestwichDepartment of Clinical Oncology, Leeds Cancer Centre, Leeds, LS9 7TF, UK. Robin.Prestwich@nhs.net.ORCID http://orcid.org/0000-0002-7872-2826
Moses ArunsinghDepartment of Clinical Oncology, Leeds Cancer Centre, Leeds, LS9 7TF, UK.
Jim ZhongDepartment of Nuclear Medicine and Radiology, Leeds Cancer Centre, Leeds, UK.
Karen E DykerDepartment of Clinical Oncology, Leeds Cancer Centre, Leeds, LS9 7TF, UK.
Sriram VaidyanathanDepartment of Nuclear Medicine and Radiology, Leeds Cancer Centre, Leeds, UK.
Andrew F ScarsbrookDepartment of Nuclear Medicine and Radiology, Leeds Cancer Centre, Leeds, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe limited positive predictive value of an incomplete response on PET-CT following (chemo)radiotherapy for head and neck squamous cell carcinoma (HNSCC) means that the optimal management strategy remains uncertain. The aim of the study is to assess the utility of a 'second-look' interval PET-CT.

methodsPatients with HNSCC who were treated with (chemo)radiotherapy between 2008 and 2017 and underwent (i) baseline and (ii) response assessment PET-CT and (iii) second-look PET-CT following incomplete (positive or equivocal scan) response were included. Endpoints were conversion rate to complete response (CR) and test characteristics of the second-look PET-CT.

resultsFive hundred sixty-two patients with HNSCC underwent response assessment PET-CT at a median of 17 weeks post-radiotherapy. Following an incomplete response on PET-CT, 40 patients underwent a second-look PET-CT at a median of 13 weeks (range 6-25) from the first response PET-CT. Thirty-four out of 40 (85%) patients had oropharyngeal carcinoma. Twenty-four out of 40 (60%) second-look PET-CT scans converted to a complete locoregional response. The primary tumour conversion rate was 15/27 (56%) and the lymph node conversion rate was 14/19 (74%). The sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the second-look PET-CT were 75%, 75%, 25% and 96% for the primary tumour and 100%, 92%, 40% and 100% for lymph nodes. There were no cases of progression following conversion to CR in the primary site or lymph nodes.

conclusionsThe majority of patients who undergo a second-look PET-CT convert to a CR. The NPV of a second-look PET-CT is high, suggesting the potential to avoid surgical intervention. KEY POINTS: • PET-CT is a useful tool for response assessment following (chemo)radiotherapy for head and neck squamous cell carcinoma. • An incomplete response on PET-CT has a limited positive predictive value and optimal management is uncertain. • These data show that with a 'second-look' interval PET-CT, the majority of patients convert to a complete metabolic response. When there is doubt about clinical and radiological response, a 'second-look' PET-CT can be used to spare patients unnecessary surgical intervention.

Indexed as

Positron Emission Tomography Computed TomographyAdultAgedAged, 80 and overChemoradiotherapyFemaleFluorodeoxyglucose F18Head and Neck NeoplasmsHumansLymph NodesMaleMiddle AgedNeoplasm StagingRetrospective StudiesSensitivity and SpecificitySquamous Cell Carcinoma of Head and NeckFluorodeoxyglucose F18ChemotherapyHead and neck cancerPET-CTRadiotherapyRecurrence

Identifiers

PMID31485835

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.