TABLE 2.
Characteristics of 14 patients with positive postoperative positron emission tomography/CT scans.
| Patient no. | Sex | Age, y | Site | Ipsilateral neck dissection | Margin status | Stage | ECS | PNI | PET result | Management change | Status at last follow-up |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F | 46 | Lateral tongue | Levels 1–4 | Close (<1 mm) | T2N2b | Yes | Yes | Breast primary | No change in head and neck treatment. Treated to 66 Gy. Patient went on for breast treatment. | Alive with disease |
| 2 | M | 49 | Lateral tongue | Levels 1–5 | Positive | T3N2b | Yes | Yes | Resection margin: Levels 3–5 ipsilateral. Level 2 contralateral. |
Treated to higher dose of radiation with cetuximab (70 Gy) | Alive with disease |
| 3 | M | 56 | Lower gum | Levels 1–3 | Positive | T4N0 | N/A | No | Resection margin | Treated to higher dose of radiation with cisplatin (70 Gy). | Distant metastasis |
| 4* | M | 57 | Ventral tongue | Levels 1–4 | Negative | T1N2b | Yes | No | Uptake in mediastinum | Biopsy of mediastinum. Treated to higher dose of radiation. On protocol 08-138 (70 Gy). | No evidence of disease |
| 5*,† | M | 50 | Lateral tongue | Levels 1–4 | Close (0.3 mm) | T3N2b | No | Yes | Uptake at hyoid bone/ resection margin. | Treated to higher dose of radiation on protocol 10-081 (70 Gy). | No evidence of disease |
| 6† | F | 62 | Hard palate | Levels 1–3 | Close (4 mm) | T3N0 | N/A | Yes | Uptake in mediastinum | Biopsy of mediastinum. Treated to higher dose of radiation (70 Gy). | No evidence of disease |
| 7 | M | 72 | Lateral tongue | Levels 1–5 | Negative | T2N2a | No | Yes | Contralateral level 3 neck | Additional biopsy and surgery of neck (level 3). Standard postoperative doses. | No evidence of disease |
| 8 | F | 56 | Lateral tongue | Levels 1–4 | Negative | T1N2b | Yes | No | Ipsilateral level 1 neck | Additional biopsy and surgery of neck (level 1). Treated to higher dose of radiation on protocol 08-138 (70 Gy). | No evidence of disease |
| 9 | M | 84 | Ventral tongue | Levels 1–4 | Close (1 mm) | T2N0 | N/A | No | Uptake in a nodular area in left floor of mouth. Uptake in lung primary. | Treated to higher dose of radiation with carboplatin (70 Gy). | No evidence of disease |
| 10 | M | 44 | Lateral tongue | Levels 1–5 | Negative | T4N1 | Yes | Yes | Ipsilateral level 1 neck | Treated to higher dose of radiation with cisplatin (70 Gy). | Alive with disease |
| 11*,‡ | F | 60 | Oral tongue | N/A | Close (<0.6 mm) | rT2N1 | No | No | Focal uptake with associated soft tissue fullness and focal enhancement. | Treated to higher dose of radiation with cisplatin (70 Gy). | No evidence of disease |
| 12 | M | 76 | Oral tongue | Levels 1–5 | Close (<0.5 mm) | TxN1 | Yes | No | Uptake in soft tissue mass in submandibular area and ipsilateral neck. | Additional biopsy and surgery in the head and neck. Standard RT (66 Gy) with cisplatin after additional surgery. | Distant metastasis |
| 13§ | F | 36 | Buccal mucosa | Levels 1–4 | Negative | T3N2b | No | Yes | Uptake in area lateral to mandibular condyle. | Treated to higher dose of radiation (74 Gy) with cetuximab. | Local recurrence |
| 14†,§ | F | 72 | Oral tongue | Levels 1–4 | Close (<0.6 mm) | T3N2b | Yes | Yes | Uptake adjacent to flap SUV and at ipsilateral neck. Additional <1 cm lesions. | Treated to higher dose of radiation with cisplatin (70 Gy). | Distant metastasis |
Abbreviations: ECS, extracapsular spread; PNI, perineural invasion; PET, positron emission tomography; N/A, not applicable; RT, radiotherapy; SUV, standardized uptake value.
*
No preoperative PET/CT.
†
Contralateral neck levels 1–3 dissected.
‡
Recurrent setting.
§
Received neoadjuvant chemotherapy.
Patients with abnormal PET/CT scans felt to require changes in treatment.