Published online May 28, 2016. doi: 10.5319/wjo.v6.i2.23
Peer-review started: August 27, 2015
First decision: September 28, 2015
Revised: November 9, 2015
Accepted: March 17, 2016
Article in press: March 18, 2016
Published online: May 28, 2016
Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma (HNSCC). Imaging studies such as contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) and 18F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography (18F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.
Core tip: In the pre-treatment phase, positron-emission tomography/computed tomography (PET/CT) is valuable in the evaluation of patients with carcinoma of unknown primary origin, detection of synchronous second primary tumor, staging of cervical lymph node metastasis and assessment for distant metastases. In the post-treatment phase, PET/CT is helpful in evaluating treatment response, detecting residual or recurrent tumor and excluding distant metastases. Prognostic factors derived from PET/CT metabolic and functional data are useful in predicting tumor aggressiveness with implication on patient’s survivability, and facilitate selection of treatment modality and personalized treatment options.