Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Nov 28, 2015; 7(11): 382-393
Published online Nov 28, 2015. doi: 10.4329/wjr.v7.i11.382
Application of positron emission tomography/computed tomography in radiation treatment planning for head and neck cancers
Musaddiq J Awan, Farzan Siddiqui, David Schwartz, Jiankui Yuan, Mitchell Machtay, Min Yao
Musaddiq J Awan, Jiankui Yuan, Mitchell Machtay, Min Yao, Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
Farzan Siddiqui, Department of Radiation Oncology, Henry Ford Health System, Detroit, MI 48202, United States
David Schwartz, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Author contributions: Awan MJ, Siddiqui F and Yao M contributed equally to this work; Siddiqui F, Schwartz D and Yao M contributed to case examples; Yuan J contributed to the data collection and image process; Awan MJ, Siddiqui F, Schwartz D, Yuan J, Machtay M, and Yao M all contributed to writing and editing the paper.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose related to the publication of this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Min Yao, MD, PhD, Professor, Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, United States.
Telephone: +1-216-8443103 Fax: +1-216-8442005
Received: May 29, 2015
Peer-review started: June 1, 2015
First decision: June 18, 2015
Revised: July 8, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: November 28, 2015

18-fluorodeoxygluocose positron emission tomography/computed tomography (18FDG-PET/CT) provides significant information in multiple settings in the management of head and neck cancers (HNC). This article seeks to define the additional benefit of PET/CT as related to radiation treatment planning for squamous cell carcinomas (SCCs) of the head and neck through a review of relevant literature. By helping further define both primary and nodal volumes, radiation treatment planning can be improved using PET/CT. Special attention is paid to the independent benefit of PET/CT in targeting mucosal primaries as well as in detecting nodal metastases. The utility of PET/CT is also explored for treatment planning in the setting of SCC of unknown primary as PET/CT may help define a mucosal target volume by guiding biopsies for examination under anesthesia thus changing the treatment paradigm and limiting the extent of therapy. Implications of the use of PET/CT for proper target delineation in patients with artifact from dental procedures are discussed and the impact of dental artifact on CT-based PET attenuation correction is assessed. Finally, comment is made upon the role of PET/CT in the high-risk post-operative setting, particularly in the context of radiation dose escalation. Real case examples are used in these settings to elucidate the practical benefits of PET/CT as related to radiation treatment planning in HNCs.

Keywords: Head and neck cancer, Radiation treatment planning, Computed tomography, Fluorodeoxygluocose positron emission tomography, Imaging

Core tip: The 18-fluorodeoxygluocose positron emission tomography (18FDG-PET) scan has increasing clinical importance in the management of head and neck cancers. It has also proven useful in treatment planning for radiation therapy. PET scans have utility in tumor volume delineation, the identification of metastatic lymph nodes, the management of carcinoma of unknown primary, dental artifact reduction and high-risk postoperative radiation therapy. Many of these applications of 18FDG-PET scans are still in the preliminary stages of development and active investigations are ongoing to standardize these processes.