Impact of pretreatment second look 18FDG-PET/CT on stage and treatment changes in head and neck cancer.

Eliçin, Olgun; Vollnberg, Bernd; Shelan, Mohamed; Riggenbach, Elena; Bojaxhiu, Beat; Mathier, Etienne; Giger, Roland; Aebersold, Daniel M.; Klaeser, Bernd (2021). Impact of pretreatment second look 18FDG-PET/CT on stage and treatment changes in head and neck cancer. Clinical and translational radiation oncology, 31, pp. 8-13. Elsevier 10.1016/j.ctro.2021.08.007

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Patients diagnosed with locoregionally advanced head and neck squamous cell carcinoma (LAHNSCC) regularly undergo staging with 18F-FDG PET/CT in our center. In cases of delays in radiotherapy (RT) planning CT more than 4 weeks after initial PET/CT or clinically suspected progress, PET/CT is repeated for restaging and as an RT planning reference. Our aim was to determine the impact of second-look PET/CT on stage migration, treatment change and RT planning.


Consequent treatment changes were categorized as minor and major. Minor changes were defined as PET/CT-based modifications of RT plans, e.g., the addition of anatomical compartments, changes in high- and low-risk dose levels or both. Major changes included changes from curative to palliative treatment intent and alterations of interdisciplinary treatment plans, such as the addition of induction chemotherapy, switch to primary surgery, no treatment and/or the necessity of additional diagnostic work-up resulting in the postponement or cancellation of treatment.


Thirty-two newly diagnosed LAHNSCC patients who were treated between 2014 and 2018 underwent second-look PET/CT (median interval 42.5 days). Second-look PET/CT led to locoregional and distant upstaging in 3/32 and 1/32 patients, respectively. In 1/32 patients (3%), second-look PET/CT led to a palliative approach with systemic treatment. New lymph node metastases were discovered in 16 patients, 6 of whom also showed significant progression of the primary tumor, resulting in minor changes in 16 of the remaining 31 patients (52%) who were treated curatively.


If RT treatment planning of LAHNSCC was delayed by more than 4 weeks after initial PET/CT staging or when progression was clinically suspected, a second look at 18FDG-PET/CT was performed. This led to changes in treatment planning in more than half of the cases, which is expected to directly influence oncologic outcomes.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Clinic of Nuclear Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)

UniBE Contributor:

Eliçin, Olgun, Vollnberg, Bernd Olaf, Shelan, Mohamed, Riggenbach, Elena, Bojaxhiu, Beat, Mathier, Etienne, Giger, Roland, Aebersold, Daniel Matthias, Klaeser, Bernd


600 Technology > 610 Medicine & health








Beatrice Scheidegger

Date Deposited:

07 Oct 2021 09:32

Last Modified:

05 Dec 2022 15:53

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Head and neck cancer Positron emission tomography Radiotherapy Squamous cell carcinoma Staging




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