Post-operative PET/CT improves the detection of early recurrence of squamous cell carcinomas of the oral cavity.
Yao Yu, Heiko Schöder, Kaveh Zakeri, Linda Chen, Jung Julie Kang, Sean Matthew McBride, C Jillian Tsai, Daphna Y Gelblum, Jay O Boyle, Jennifer R Cracchiolo, Marc A Cohen, Bhuvanesh Singh, Ian Ganly, Snehal G Patel, Loren S Michel, Lara Dunn, Eric J Sherman, David G Pfister, Richard J Wong, Nadeem Riaz, Nancy Y Lee
Author Information
Yao Yu: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
Heiko Schöder: Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, United States.
Kaveh Zakeri: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
Linda Chen: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
Jung Julie Kang: Department of Therapeutic Radiology, Yale School of Medicine, United States.
Sean Matthew McBride: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
C Jillian Tsai: Department of Radiation Oncology, Princess Margaret Cancer Center, Canada.
Daphna Y Gelblum: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
Jay O Boyle: Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
Jennifer R Cracchiolo: Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
Marc A Cohen: Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
Bhuvanesh Singh: Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
Ian Ganly: Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
Snehal G Patel: Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
Loren S Michel: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States.
Lara Dunn: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States.
Eric J Sherman: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States.
David G Pfister: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States.
Richard J Wong: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States.
Nadeem Riaz: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
Nancy Y Lee: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States. Electronic address: leen2@mskcc.org.
BACKGROUND: We evaluate the impact of post-operative 18-fluorodeoxyglucose positron emission tomography with computed tomography (PET/CT) for radiation planning on the detection of early recurrence (ER) and treatment outcomes in oral squamous cell carcinoma (OSCC). METHODS: We retrospectively reviewed the records of patients treated with post-operative radiation between 2005 and 2019 for OSCC at our institution. Extracapsular extension and positive surgical margins were classified as high risk features; pT3-4, node positivity, lymphovascular invasion, perineural invasion, tumor thickness >5 mm, and close surgical margins were considered intermediate risk features. Patients with ER were identified. Inverse probability of treatment weighting (IPTW) was used to adjust for imbalances between baseline characteristics. RESULTS: 391 patients with OSCC were treated with post-operative radiation. 237 (60.6%) patients underwent post-operative PET/CT planning vs. 154 (39.4%) who were planned with CT only. Patients screened with post-operative PET/CT were more likely to be diagnosed with ER than those planned with CT only (16.5 vs. 3.3%, p < 0.0001). Among patients with ER, those with intermediate features were more likely than those high risk features to undergo major treatment intensification, including re-operation, the addition of chemotherapy, or intensification of radiation by ≥ 10 Gy (91% vs. 9%, p < 0.0001). Post-operative PET/CT was associated with improved disease-free and overall survival for patients with intermediate risk features (IPTW log-rank p = 0.026 and p = 0.047, respectively) but not high risk features (IPTW log-rank p = 0.44 and p = 0.96). CONCLUSIONS: Use of post-operative PET/CT is associated with increased detection of early recurrence. Among patients with intermediate risk features, this may translate to improved disease-free survival.
