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Complete Pathologic Response to Neoadjuvant Pembrolizumab Captured on Intraoperative PET/CT: A Case Report and
Joaquin Austerlitz1, Andreja Radevic1, Ashtyn McAdoo1,2,3
1Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Background:
Neoadjuvant immunotherapy is an emerging treatment for patients with head and neck cancer. Given the heterogeneity of response, novel methods of intraoperative tumor and margin assessment warrant investigation.
Methods:
A 55-year-old male presented with a cT3N2c supraglottic squamous cell carcinoma with a combined positive score of 5. The patient received 2 cycles of neoadjuvant pembrolizumab prior to laryngectomy. The specimen underwent intraoperative micro-positron emission tomography/computed tomography (micro-PET/CT) imaging.
Results:
Final pathology demonstrated a pathologic complete response (pCR). On pre-treatment whole body PET/CT, maximum standardized uptake value (SUVmax) was 21.8 in the tumor and 10.7 (~50%) at the tracheostomy site. Intraoperative micro-PET/CT showed residual uptake in the tumor region (SUVmax 16.1) and tracheostomy site (SUVmax 16.9).
Conclusion:
In this case report of pCR, intraoperative micro-PET/CT demonstrated similar avidity at the primary tumor site compared to the tracheostomy site, highlighting the potential utility of this novel imaging approach in patients receiving neoadjuvant immunotherapy.
