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Head and Neck Cancer Soft Tissue Radiation Necrosis-Diagnostic Challenge
Darko Pucar, Michael W Groves1, Paul Biddinger2
1Otorhinolaryngology, and.
Clinical Nuclear Medicine
|October 30, 2018
Summary
Chemoradiation for tongue base cancer can cause radiation necrosis mimicking tumor progression on PET scans. Non-enhancing ulcerations on CT scans may indicate necrosis, guiding treatment decisions effectively.
Area of Science:
- Oncology
- Radiology
- Nuclear Medicine
Background:
- Squamous cell carcinoma of the tongue base is a challenging diagnosis.
- Definitive chemoradiation is a standard treatment for advanced head and neck cancers.
- Interpreting imaging findings after treatment can be difficult due to treatment effects.
Purpose of the Study:
- To evaluate the utility of FDG PET/CT and contrasted CT in differentiating post-treatment changes from recurrent squamous cell carcinoma.
- To assess the role of non-enhancing ulceration on CT in predicting radiation necrosis.
Main Methods:
- A case study of a 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma treated with chemoradiation.
- Serial imaging with FDG PET/CT and contrasted CT at 6, 9, and 12 weeks post-treatment.
- Biopsy of the primary site at 9 weeks.
- Salvage surgery at 12 weeks.
Main Results:
- Initial FDG PET/CT showed partial metabolic response with radiation necrosis at the primary site and complete response in the neck.
- Contrasted CT at 9 weeks revealed worsening non-enhancing ulceration, with biopsy showing a minute carcinoma focus with treatment effect.
- Follow-up FDG PET/CT at 12 weeks indicated disease progression due to increased uptake at the primary site.
- Salvage surgery confirmed no viable tumor, indicating the increased uptake was due to radiation necrosis.
Conclusions:
- Interpreting FDG PET/CT findings requires careful consideration of potential treatment effects like radiation necrosis.
- Non-enhancing ulceration on contrasted CT can be a reliable indicator of pure radiation necrosis, even with increased FDG uptake.
- Contrasted CT may be crucial in guiding treatment decisions in cases with ambiguous PET/CT findings after chemoradiation for tongue base cancer.
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