肿瘤患者中HIV感染状况的初步调查分析

目的:探讨肿瘤患者中人类免疫缺陷病毒(HIV)感染情况及肿瘤分布特点,以协助临床诊断和治疗,防止HIV院内传播.方法:对我院2005年2月至2010年5月期间,57 916例肿瘤患者中检出HIV抗体阳性患者的临床资料进行回顾性统计分析.结果:患者中检出HIV抗体阳性41例,占总检测例数的0.071%;2005年至2010年6年中,分别为3例、1例、6例、9例、12例、10例;其中肺癌7例、颈部肿瘤6例、肝癌5例,分别占阳性总数的17.1%、14.6%、12.2%.结论:肿瘤患者中HIV阳性病例数有逐年增加的趋势,对肿瘤患者手术前、输血前和各种创伤性检查前有必要进行HIV常规检查.     

获得性免疫缺陷综合征合并淋巴瘤24例

 【摘要】　目的　总结获得性免疫缺陷综合征（AIDS）合并淋巴瘤的临床特点。方法　收集24例AIDS合并淋巴瘤患者临床资料,并从流行病学、临床表现、实验室检查、治疗及预后等指标进行回顾性分析。结果　24例人类免疫缺陷病毒（HIV）感染无症状或AIDS合并淋巴瘤患者,根据淋巴组织肿瘤WHO（2001）分型,其中B细胞肿瘤15例,占62.5 %;T细胞和NK细胞肿瘤7例,占29.2 %;霍奇金淋巴瘤2例,占8.3 %。结论　HIV感染后易合并淋巴组织肿瘤,以B细胞肿瘤多见,因此,淋巴瘤患者须行HIV抗体检查,以尽早确诊和治疗。     

人类免疫缺陷病毒相关霍奇金淋巴瘤22例临床分析

目的探讨人类免疫缺陷病毒(HIV)相关霍奇金淋巴瘤患者的临床特征、疗效及预后。方法回顾性病例系列研究。回顾性分析2013年12月至2022年6月重庆大学附属肿瘤医院诊治的22例HIV相关霍奇金淋巴瘤患者临床资料, 分析其临床特征、实验室检查结果、治疗情况及预后。采用Kaplan-Meier法进行生存分析。结果 22例患者年龄[M(Q1, Q3)]44岁(36岁, 53岁);男性18例, 女性4例;临床分期Ⅲ期5例, Ⅳ期17例。22例患者均通过性传播感染HIV, 其中10例通过男男性传播感染, 12例通过异性性传播感染。9例为诊断淋巴瘤时发现感染HIV, 13例确诊感染HIV 22.2个月(12.3个月, 38.4个月)后发现淋巴瘤。22例患者中, 3例放弃治疗;19例患者采用抗反转录病毒治疗联合ABVD方案化疗, 其中9例完全缓解, 10例部分缓解。随访46.8个月(24.8个月, 64.5个月), 5年无进展生存率为83.9%, 5年总生存率为89.5%。结论 HIV相关霍奇金淋巴瘤患者临床呈侵袭性过程, 规范的抗反转录病毒治疗联合ABVD方案化疗可使患者获得长期生存。     

肿瘤患者医院感染的临床分析

医院感染是肿瘤患者常见并发症之一,也是影响其预后的重要因素。了解肿瘤患者医院感染的特点和危险因素,对指导临床工作有重要意义。一、资料与方法1.一般资料:2001年1月至2005年12月我科收治各种恶性肿瘤患者356例。根据临床及细菌学培养诊断为医院感染者101例,男71例,女30例。年龄28~90岁,中位年龄55岁。平均住院日48 d。2.诊断标准:所有患者均有明确的细菌学培养阳性结果。医院感染病原菌以不同时期、检出同种病原菌两次以上为阳性。二、结果1.原发病的构成:以肺癌构成比占首位(31.7%,表1)。2.感染的临床类型:356例肿瘤患者发生感染101例…     

肿瘤专科医院恶性肿瘤院内感染123例临床分析

目的探讨肿瘤专科医院化疗科恶性肿瘤患者院内感染的发生率、相关因素及防治对策。方法对2009年1月-2009年12月本院化疗科住院的3 316例患者中123例发生院内感染的恶性肿瘤患者的资料进行回顾性分析,包括感染部位、感染致病菌、患者年龄、肿瘤期别、住院时间等,并初步探讨院内感染的防治。结果本组院内感染率、病死率为3.8%、17.1%。感染与年龄、肿瘤期别、抗肿瘤治疗和侵袭性操作密切相关。感染主要部位是下呼吸道、泌尿道,分别占53.7%、16.3%。病原体阳性患者112例,共检出致病菌株127例,有9例为合并几种菌感染。感染主要菌种为革兰氏阴性菌占67株(52.8%),其中前3位是肺炎鲍曼不动杆菌18株(14.2%),克雷伯菌16株(12.6%),铜绿色假单胞菌14株(11.0%)。真菌36株(28.3%);革兰氏阳性菌24株(18.9%),主要是表皮葡萄球菌。结论恶性肿瘤患者院内感染常由条件致病菌引起,住院时间长、放化疗结合、老年及晚期肿瘤患者是院内感染的主要危险因素。降低院内感染,应采取综合措施。     

2006~2020年1025例早期胃癌临床病理学特征及年代变化趋势分析

目的;分析1025 例早期胃癌患者的临床病理学特征及 15 年来的年代变化趋势,以期为早期胃癌的人群研究提供参考。方法∶收集巴中市中心医院2006 年1月至2020年12 月诊断的早期胃癌病例,回顾性分析患者的临床病理特征资料,采用卡方检验分析不同人口学因素、不同年代与各临床病理特征间的关系。结果∶166 260 例行胃镜检查患者中,共检出胃癌患者4 846 例,检出率为2.91%,早期胃癌患者1 025 例,早期胃癌检出率为0.62%,早期胃癌占全部胃癌比例 21.2%。男性检出率明显高于女性（0.78% s 0.44%;x²=78.924,P<0.001）。早期胃癌检出率的年龄分布中,<40岁、40～49 岁、50～59 岁、≥60 岁4个年龄组的检出率分别为0.20%,0.48%,0.60%, 0.92%,胃癌的检出率随着年龄增长而增加,差异有统计学意义（xas= 191.635,P<0.001）。临床病理特征分布∶肿瘤最大径≤2cm者占64.20% 、肿瘤浸润至黏膜层638 例（62.24%）、分化型611 例（59.61%）、合并溃疡者467 例（45.56%）、胃窦（48.00%）、胃体（30.73%）、贲门/胃底（21.27%）、肿瘤标记物检测阳性 182 例（17.16%）、淋巴结转移 174 例（16.98%）、幽门螺杆菌检测阳性 127 例（12.96%）、神经侵犯99 例（9.66%）、脉管浸润44 例（4.29%）。近 15 年来胃镜检查早期胃癌的检出率呈逐年上升趋势。2010 年代以后增加明显,年代变化趋势分析发现≤2 cm 小胃癌的检出例数及构成比逐年增加,差异有统计学意义（P<0.001）;早期胃癌未伴淋巴结转移的检出数量和比例逐年增加（P=0.003）,黏膜内癌的检出比例逐年上升（P=0.007）。结论∶早期胃癌检出率逐年升高,直径≤2 cm 胃癌、黏膜内癌、未出现淋 巴转移早期胃癌检出率升高。     

肿瘤化疗病人院内感染特点及护理对策

肿瘤病人实施化疗后 ,免疫力的进一步下降 ,容易诱发感染。在我国医院感染的病例中 ,以呼吸系统感染居首位 ,占医院感染总例数的 2 3 3%～ 4 2 0 %。对 1999年 4月至 2 0 0 2年 8月 ,在我科实施化疗的肿瘤患者出现下呼吸道感染后的痰细菌培养结果进行分析 ,报道如下。同时对院内感染的预防及护理谈点粗浅看法。1　临床资料标本均来自住院肿瘤患者 ,共 117例 ,其中男 84例 ,女 33例 ,年龄 18～ 71岁。包括肺癌、食管癌、乳腺癌、大肠癌等。实施化疗二周至六周不等 ,有呼吸道感染症状者 ,留取痰标本 ,送检验科培养。并要求做药敏试验。2　结…     

肿瘤医院病原菌的分布及耐药分析

目的 了解肿瘤患者医院感染的病原菌分布及其耐药特征.方法 对山西省肿瘤医院2009年1月至2011年12月肿瘤患者医院感染的病原菌及耐药情况进行统计分析.结果 共检出病原菌6347株,其中革兰阴性菌3737株,占58.9％,真菌1907株,占30.0％,革兰阳性菌703株,占11.1％.主要病原菌是大肠埃希菌、白假丝酵母菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌.大肠埃希菌对青霉素类、头孢呋辛、头孢噻肟和喹诺酮类的药物耐药明显,耐药率在60.0％以上,铜绿假单胞菌对亚胺培南和美洛培南的耐药率达到32.7％和30.5％.结论 肿瘤医院患者院内感染的病原菌及耐药特征与其他医院感染有所不同,以呼吸道感染条件致病菌为主.     

2006—2007年中山大学附属肿瘤医院患者医院感染病原菌分布特点及耐药性分析

背景与目的：肿瘤患者免疫力低下,容易发生感染,不仅给肿瘤的治疗带来困难,也是肿瘤患者死亡的重要原因。本研究主要对发生医院感染的肿瘤住院患者的易感因素、病原菌分布及耐药情况进行分析。方法：回顾性调查中山大学附属肿瘤医院2006—2007年发生医院感染的952例住院患者的临床资料,采用EXCEL8．0和SPSS10．0对医院感染一般情况、病原菌分布及耐药情况进行统计和分析。结果：952例发生医院感染的患者中,分离出了病原菌794例,检出率为83．4％。其中检出革兰阴性杆菌321例,占所有病原菌的40．4％,主要是大肠埃希菌感染;真菌265例,占33．4％,以白色假丝酵母菌感染为主;革兰阳性球菌208例,占26．2％,主要是葡萄球菌属和链球菌属感染。药敏结果提示革兰阴性杆菌主要对亚胺培南、丁胺卡那敏感,而对氨苄西林的耐药率则在90％以上：革兰阳性球菌对万古霉素高度敏感。此次调查中没有发现对万古霉素耐药细菌,而对氨苄西林耐药严重：真菌对两性霉素B、伏立康唑及氟胞嘧啶敏感,而对氟康唑的敏感性稍差。结论：中山大学附属肿瘤医院2006—2007年住院患者医院感染病原菌主要为革兰阴性杆菌,临床用药应根据药敏结果合理使用抗生素,减少真菌感染和细菌耐药,从而有效预防和控制感染。     

山西省肿瘤医院2005年至2010年住院患者死因分析

 目的　分析山西省肿瘤医院2005年至2010年住院患者的死因构成。方法　回顾性分析山西省肿瘤医院2005年至2010年住院死亡 1277例患者的临床资料。结果　2005年至2010年住院患者总的死亡率为0.86 %（1277／146 820）,且有逐年下降的趋势,2005年至2010年死亡率分别为1.16 %、1.05 %、0.99 %、0.85 %、0.84 %、0.64 %,差异有统计学意义（χ2＝45.763,P＜0.001）;住院患者中男性总死亡率（1.26 %）高于女性（0.53 %）,差异有统计学意义（χ2＝215.367,P＜0.001）;肿瘤死因顺位分析结果显示,肺癌占癌症死因比例最高,为36.4 %（456／1253）。前10位肿瘤死因顺位分析结果表明,男性、干部职员和工人、中学文化程度、60岁以上人群在肿瘤死亡患者中占大多数。 结论　山西省肿瘤医院患者死因构成的确定为疾病防治提供了科学依据。     

10例头颈部髓外浆细胞瘤的临床分析及文献复习

背景与目的:髓外浆细胞瘤(extramedullary plasmacytoma,EMP)为一种罕见肿瘤,主要发生在头颈部,约80%的EMP发生于上呼吸道及上消化道。在临床表现和病理学上,该肿瘤极易与头颈部常见的一些肿瘤相混淆。本研究通过回顾性分析,探讨头颈部髓外浆细胞瘤的临床特点及其诊断及治疗。方法:回顾分析我院1977年1月～2003年12月期间收治的10例头颈部髓外浆细胞瘤患者的资料,全组10例患者中,单纯手术治疗2例、手术加辅助放疗2例、根治性放疗5例(其中1例于放疗后行辅助化疗),1例未治疗。结果:临床表现主要表现为局部肿物及其引起的相应症状。本组患者所有病例均经病理学诊断为浆细胞瘤,3例行免疫组化检测IgG,1例为λ型,2例为κ型。6例检测过尿本周蛋白均为阴性;4例检测过M蛋白,均为阴性;4例骨髓穿刺均未见异常;4例全身骨X线检查均正常。末次随访2004年5月,随访率90%,6例无瘤生存的患者中有5例无瘤生存时间超过1年(其中3例超过15年);死亡3例;失访1例。结论:EMP的诊断主要依靠临床表现和病理;放疗和手术是治疗头颈部髓外浆细胞瘤的主要手段。     

CBNAAT: A Boon for Early Diagnosis of Tuberculosis-Head and Neck

Tuberculosis of head and neck has been an under diagnosed entity due to large number of smear negative cases, which results in missing out the positive cases, further increasing the burden of TB. The role of cartridge- based nucleic acid amplification test (CBNAAT) with a potential to diagnose TB and rifampicin resistance within 2 h is promising. The study highlights the extended implications of CBNAAT in infectious lesions of head and neck, where the pus or aspirate was subjected to this test, along with other investigations which have been routinely used for detection of extra pulmonary tuberculosis. Twelve patients with infective lesions of head and neck were included in this prospective study, conducted in Department of Otorhinolaryngology, Netaji Subhash Chandra Bose Medical College and hospital, Jabalpur from September 2016 to March 2017. They were investigated for pulmonary and extra pulmonary TB. CBNAAT, microscopy, FNAC and HPR from the site of lesion were done. Nine out of twelve patients were diagnosed positive for Tuberculosis. Microscopy (ZN staining) could detect only two such cases, whereas FNAC showed granulomatous lesion in 3 cases (33.3%). CBNAAT was positive in 77.7% of the total positive cases. Histopathological examination showed 100% results but was feasible only in selected number of cases (4 in this study). CBNAAT provides a promising role in early diagnosis of TB in head and neck. Its high sensitivity and less time taking procedure makes it an excellent tool for timely diagnosis of such cases.     

Manifestations of Tuberculosis in Otorhinolaryngology Practice: A Retrospective Study Conducted in a Coastal City of South India

Tuberculosis (TB) of the head and neck has proved to be a diagnostic challenge for otorhinolarynologists around the world and is often misdiagnosed as cancer. To contribute to a better understanding of TB in the head and neck region by assessing its various manifestations, presentations, diagnostic techniques, risk factors, coexisting illnesses and treatment modalities. This was a retrospective study conducted over a 3 year period (2012–2014) in 2 hospitals in South India, among patients diagnosed to have TB of the head and neck. A semi structured proforma was used to capture information from the medical records pertaining to the various objectives of the study. Data was analysed using SPSS version 16.0 and results obtained were depicted as percentages. Chi-square test was used to find association between the variables and p < 0.05 was considered statistically significant. Among 104 patients with TB of the head and neck, the most common manifestation was found to be Tubercular Lymphadenitis (86.53%), followed by laryngeal TB, submandibular gland TB, deep neck space abscess and adenotonsillar TB. FNAC was found to be the gold standard for the diagnosis of TB lymphadenitis. 26% of the patients had coexisting HIV infection and 16.3% of the patients had associated pulmonary TB. More than 20% of the patients were smokers. Most patients were treated using ATT. Tuberculosis of head and neck is no longer uncommon. Pulmonary TB need not be associated nor is smoking a risk factor according to our study.     

Spectrum of HIV/AIDS related cancers in India

Objective To study the cancer pattern among HIV positive cancer cases. Method The study group included patients registered in the HIV Cancer clinic at the Tata Memorial Hospital (TMH), Mumbai, which is the largest tertiary referral cancer center in India. We used the gender and age-specific proportions of each cancer site of the year 2002 that was recorded in the Hospital Cancer Registry to estimate an expected number of various cancer sites among HIV positive cancer patients during the period 2001–2005. The observed number of site-specific cancer cases was divided by the expected number to obtain proportional incidence ratio (PIR). Results No case of Kaposi’s sarcoma was observed. Increased proportion of non- Hodgkin’s lymphoma (NHL) was observed (PIR in males = 17.1, 95%CI 13.33-21.84, females = 10.3, 95%CI 6.10-17.41).In males, PIR was increased for anal cancer (PIR = 10.3, 95%CI 4.30–24.83), Hodgkin’s disease, testicular cancer, colon cancer, and few head and neck cancer sites. Among females, the PIRs for cervical cancer (PIR = 4.1, 95%CI 2.90–5.75), vaginal cancer (PIR = 7.7, 95%CI 2.48–23.85), and anal cancer (PIR = 6.5, 95%CI 0.91–45.88) were increased. Conclusions The absence of Kaposi’s sarcoma and increased PIRs for certain non –AIDS defining cancers among HIV infected cancer cases indicates a different spectrum of HIV associated malignancies in this region. The raised PIR for cervical cancer emphasizes the urgent need for screening programs for cervical cancer among HIV infected individuals in India.     

The diagnostic and prognostic utility of positron emission tomography/computed tomography‐based follow‐up after radiotherapy for head and neck cancer

BACKGROUND:

The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow‐up program incorporating serial ¹⁸F?fluorodeoxyglucose?positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer.

METHODS:

A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow?up, 21 months).

RESULTS:

The sensitivity, specificity, and positive and negative predictive values of PET/CT‐based follow‐up for detecting locoregional recurrence were 92%, 82%, 42%, and 98%, respectively. Corresponding values for distant metastases or second primary tumors were 93%, 96%, 81%, and 98%, respectively. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2‐year progression‐free survival and 2‐year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively).

CONCLUSIONS:

Although post‐therapy follow‐up using PET/CT is reportedly associated with a high false‐positive rate in the irradiated head and neck, PET/CT appears to be a highly sensitive technique for the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value. Cancer 2009. © 2009 American Cancer Society.     

头颈部鳞癌预后相关肿瘤标志物的研究现状

近年来,头颈部鳞癌的治疗已经有了很大的进展,患者通过手术治疗、放疗或化疗,疾病控制和患者生活质量均可得到较大改善,但是总体生存率依旧很低,主要原因是肿瘤的复发和转移。对于头颈部鳞癌患者肿瘤复发的监测,临床医生需要借助某些手段来协助发现肿瘤的局部复发及转移,从而有助于及时采取治疗。因此,寻找一个确切的肿瘤标志物来辅助临床诊断、判断患者对治疗的反应,以及及早发现肿瘤的局部复发和转移已经成为一个需要被关注的问题。该篇文章主要综述的是目前研究认为对头颈部鳞癌可能有预后作用的肿瘤标志物。     

The distribution of human papillomavirus in tissues from patients with head and neck squamous cell carcinoma

Several types of HPVs have been shown to be associated with the development of malignant cancers in various head and neck tumors. More information on the HPV prevalence in patients with head and neck squamous cell carcinomas (SCCs) need to be obtained. In this study, formalin-fixed and paraffin-embedded tissues of 93 pathologically diagnosed head and neck SCC patients were collected from Peking University Cancer Hospital. HPV DNA sequences in tumor tissues were screened by a commercial Luminex technique for HPVs and HPV-specific PCR assays. Presence of HPV16/18 oncoprotein in tumor tissues was assessed by immunohistochemistry (IHC) with HPV16/18 E6-specific antibodies. Of the 93 patients, 16?(17.2%) cases were found to be HPV DNA-positive, including 7 HPV18-positive, 8 HPV16-positive and 1 HPV52-positive. IHC assays demonstrated that 31.2% (29/93) tested sections showed positive signals in the tumor cells. The total positive rate of HPV genome and its encoding products in the tested samples was 44.1% (41/93). Further analyses revealed that HPV infections in head and neck SCCs were significantly related with the tumor anatomic sites, showing decreasing tendency from outside (lip cancer) to inside (laryngeal cancer), but had no correlation with pathological, clinical grades and age of the patients. In all, HPV infections are commonly identified in the tumor tissues of patients with head and neck SCCs, in which HPV16 and 18 are the most prevalent HPV genotypes. Direct detection of high-risk HPV oncoprotein by IHC may be a good tool for classifying a tumor as truly HPV-associated.     

Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary

BACKGROUND: Fine-needle aspiration (FNA) biopsy often is the first diagnostic procedure performed in patients with head and neck masses. When squamous cell carcinoma (SCC) is diagnosed, proper management and improved prognosis depends on identification of the primary tumor. Recent studies have indicated that human papillomavirus (HPV) infection is associated closely with oropharyngeal SCC and that these tumors have a distinct nonkeratinizing morphology. In this study, the authors explored the value of identifying HPV-related tumors in neck metastases to determine the origin of occult primary head and neck squamous cell carcinoma (HNSCC). METHODS: Thirty FNA biopsies of neck metastases from patients with HNSCC were recovered from the authors' files from 2004 to 2005. The primary sites included 13 oropharynx, 13 oral cavity, and 4 larynx/hypopharynx. All patients had corresponding tissue samples from the neck mass and the primary carcinoma. The FNA specimens and corresponding tissue samples were classified as either nonkeratinizing SCC (NKSCC) or keratinizing SCC (KSCC). In situ hybridization for HPV (HPV-ISH) was performed using ethanol-fixed, Papanicolaou-stained smears. A positive signal was defined as dark blue or black nuclear dots. Corresponding formalin-fixed, paraffin-embedded tissue sections also were processed for HPV-ISH. RESULTS: Twenty of the 30 FNA specimens were KSCC, and 10 were NKSCC. Eight of the 10 NKSCCs originated in the oropharynx, and 2 had nonoropharyngeal origin. HPV was detected in 7 of 10 NKSCCs. Ten of 30 (33%) FNA biopsies were positive for HPV, and 9 of those biopsies were metastatic from the oropharynx. Nonkeratinzing morphology or HPV-positive ISH in FNA samples significantly predicted oropharyngeal origin (P < .0069 and P < .0004, respectively). CONCLUSIONS: NKSCC in metastatic cervical lymph nodes predicted positive HPV-ISH and was strongly suggestive of an oropharyngeal primary tumor.     

Tumor-specific methylation in saliva: a promising biomarker for early detection of head and neck cancer recurrence.

PURPOSE: Our goal was to define tumor and saliva gene methylation profile of head and neck squamous cell carcinoma and to evaluate its prognostic significance and its biomarker potential for early detection of relapse. EXPERIMENTAL DESIGN: We prospectively analyzed 11 genes by methylation-specific PCR on primary tumors, histologically normal adjacent mucosa, and saliva from 90 French patients at diagnosis and during follow-up as well as on 30 saliva specimens from control-matched patients with nonmalignant head and neck pathology. Five additional genes were analyzed on 50 tumors of the series. RESULTS: Methylation of TIMP3, ECAD, p16, MGMT, DAPK, and RASSF1 was the most frequently observed in tumors and paired saliva samples were analyzed at diagnosis, with an excellent agreement between both samples. At least one of these six genes was methylated in >75% of the samples without additional positive samples when other genes were analyzed. Methylation profile was similar in newly diagnosed and second primary cancers. Aberrant methylation was not associated with a worse prognosis. Ninety percent of normal adjacent mucosa and all control saliva samples were negative. Twenty-two patients were followed after treatment; abnormal methylation was detectable in the saliva of five patients few months before clinical and 2-deoxy-2[(18)F]fluoro-d-glucose-positron emission tomography signs of relapse, allowing curable surgery. Saliva samples were negative for the 17 other patients: 16 were in remission and only 1 relapsed. CONCLUSIONS: Gene methylation in saliva is a promising biomarker for the follow-up and early detection of still curable relapses of head and neck squamous cell carcinoma patients.     

Is FDG –PET-CT A Valuable Tool in Prediction of Persistent Disease in Head and Neck Cancer

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancercases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated withdefinitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy.Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients.Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overallsensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection ofresidual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responderswhile it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment oftreatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis.Definitely more precise criteria are required for assessment of response, there being no clear cut uptake valueindicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appearas increased uptake in control FDG PET CT.