Predictive value of fluorodeoxyglucose uptake in head and neck cancer: importance of standardization

Excerpt

In the past the majority of patients with advanced stage head and neck squamous cell carcinoma (HNSCC) were treated with a combination of surgery and radiotherapy, often at the expense of functional and cosmetic morbidity, and thus reduced quality of life. Nowadays, in an attempt to decrease the morbidity, non-surgical treatments for advanced HNSCC are increasingly applied with considerable complete remission rates. It appeared that new radiation schemes (accelerated or hyperfractionated) and combinations of chemotherapy and radiotherapy all increase remission rates. When starting an organ sparing non-surgical therapy for functionally inoperable HNSCC (i.e. too high morbidity of surgical treatment expected), salvage surgery is held in reserve for residual or recurrent disease. However, salvage surgery with curative intent is only possible in about half of such patients. Moreover, the complication rate of salvage surgery after chemoradiation is high, with wound healing problems as a well-known complication. Since non-surgical treatment itself is also associated with acute and long-term side effects, leading to compromised quality of life, patients undergoing primary non-surgical treatment (radiotherapy with or without chemotherapy) followed by salvage surgery are exposed to cumulative morbidity of all treatment modalities. Another important disadvantage of surgery for residual or recurrent tumour after radiotherapy is the fact that although it may be indicated postoperative radiotherapy is mostly no longer possible, limiting the oncological outcome of this treatment. …