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World J Radiol. Jun 28, 2014; 6(6): 238-251
Published online Jun 28, 2014. doi: 10.4329/wjr.v6.i6.238
Application of fluorodeoxyglucose positron emission tomography in the management of head and neck cancers
Farzan Siddiqui, Min Yao
Farzan Siddiqui, Department of Radiation Oncology, Henry Ford Health System, Detroit, MI 48202, United States
Min Yao, Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
Author contributions: Both authors contributed to review of literature and manuscript preparation.
Correspondence to: Min Yao, MD, PhD, Department of Radiation Oncology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States. min.yao@uhhospitals.org
Telephone: +1-216-8443103 Fax: +1-216-8442005
Received: January 3, 2014
Revised: February 16, 2014
Accepted: March 7, 2014
Published online: June 28, 2014
Abstract

The use of fluorodeoxyglucose positron emission tomography (FDG PET) scan technology in the management of head and neck cancers continues to increase. We discuss the biology of FDG uptake in malignant lesions and also discuss the physics of PET imaging. The various parameters described to quantify FDG uptake in cancers including standardized uptake value, metabolic tumor volume and total lesion glycolysis are presented. PET scans have found a significant role in the diagnosis and staging of head and neck cancers. They are also being increasingly used in radiation therapy treatment planning. Many groups have also used PET derived values to serve as prognostic indicators of outcomes including loco-regional control and overall survival. FDG PET scans are also proving very useful in assessing the efficacy of treatment and management and follow-up of head and neck cancer patients. This review article focuses on the role of FDG-PET computed tomography scans in these areas for squamous cell carcinoma of the head and neck. We present the current state of the art and speculate on the future applications of this technology including protocol development, newer imaging methods such as combined magnetic resonance and PET imaging and novel radiopharmaceuticals that can be used to further study tumor biology.

Keywords: Fluorodeoxyglucose, Positron emission tomography, Squamous cell carcinoma, Head and neck cancer, Radiation therapy planning

Core tip: Fluorodeoxyglucose positron emission tomography (FDG PET) computed tomography (CT) scans should be obtained for patients for squamous cell carcinoma of the head and neck whenever clinically indicated and feasible. Pre-treatment scans are helpful in detecting the sites of primary cancer, staging the tumor and ruling out the presence of distant metastases. For patients undergoing radiation therapy, PET/CT scans provide anatomic as well as functional information to aid in treatment planning. After completion of radiotherapy, PET scans should be obtained approximately 12 wk after treatment to assess treatment response and to determine if any salvage therapy is required for persistent, recurrent or metastatic disease.