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Technology Insight: PET and PET/CT in head and neck tumor staging and radiation therapy planning

Nature Clinical Practice Oncology volume 2, pages 526–533 (2005)Cite this article

Abstract

The evolving utilization of functional imaging, mainly 2-[18F]fluoro-2-deoxyglucose (18FDG) imaging, with positron emission tomography (PET) and PET/CT, is profoundly altering head and neck tumor staging approaches, radiation treatment planning, and follow-up management. Tumor–node–metastasis staging with PET/CT has improved the characterization of patient disease versus CT, MRI, or PET alone, thereby affecting patient disease management. Therefore, the utilization of PET/CT is appropriate for head and neck cancer staging in the initial presentation and in the recurrent setting. In the setting of radiation therapy treatment planning, PET-directed tumor volume contouring is not ready for clinical practice without further technological improvements in imaging specificity/sensitivity and resolution. Patient or organ motion might interfere with the accuracy of anatomical co-alignment, and variability in defining the threshold of imaging signals on PET images can affect the contour of the biological tumor volume. The use of PET/CT for staging and detecting both primary and recurrent head and neck cancer is valuable; however, its application in radiation treatment planning should be viewed as investigational.

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Figure 1: PET/CT images of a 58-year-old male with squamous cell carcinoma of the right tonsil.
Figure 2: Radiation treatment planning prior to definitive chemoradiation therapy.
Figure 3: Response to definitive chemoradiation therapy after 3 months.
Figure 4: Adequacy of radiation target volume delineation with PET/CT fusion.
Figure 5: Varying threshold parameters might alter the radiation target volumes.

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Author information

Authors and Affiliations

  1. Assistant Professor of Radiation Oncology,

    Steven J Frank

  2. Associate Professor of Radiation Oncology and Director of Molecular Image-guided Therapy,

    KS Clifford Chao

  3. Assistant Professor of Radiation Oncology,

    David L Schwartz

  4. the Hubert L and Olive Stringer Distinguished Professor and Chairman of the Department of Head and Neck Surgery,

    Randal S Weber

  5. the Department of Experimental Radiation Oncology,

    Smith Apisarnthanarax

  6. Associate Professor of Nuclear Medicine, all at the University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Homer A Macapinlac

Authors
  1. Steven J Frank
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  2. KS Clifford Chao
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  3. David L Schwartz
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  4. Randal S Weber
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  5. Smith Apisarnthanarax
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  6. Homer A Macapinlac
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Corresponding author

Correspondence to KS Clifford Chao.

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The authors declare no competing financial interests.

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Frank, S., Chao, K., Schwartz, D. et al. Technology Insight: PET and PET/CT in head and neck tumor staging and radiation therapy planning. Nat Rev Clin Oncol 2, 526–533 (2005). https://doi.org/10.1038/ncponc0322

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