Abstract
In advanced oral squamous cell carcinoma (OSCC), accurate planning of surgical resection and reconstruction are crucial for outcome and postoperative function. For OSCC close to the maxilla or mandible, prediction of bone invasion is necessary. The aim of this study was to examine whether metabolic tumor imaging obtained by fluorodeoxyglucose positron emission tomography (FDG-PET) could enhance preoperative predictability of bone invasion. We performed an analysis of 84 treatment-naïve OSCCs arising from gum (upper and lower), hard palate, floor of mouth, and retromolar trigone treated at the University Hospital Zurich, Switzerland, who underwent wide local excision with free flap reconstruction between 04/2010 and 09/2018 and with available preoperative FDG-PET. Prediction of bone invasion by metabolic tumor imaging such as maximum standardized uptake value (SUVmax) was examined. On definitive histopathology, bone invasion was present in 47 of 84 cases (56%). The probability of bone infiltration increased with a higher pretherapeutic SUVmax in an almost linear manner. A pretherapeutic SUVmax of primary tumor below 9.5 ruled out bone invasion preoperatively with a high specificity (97.6%). The risk of bone invasion was 53.6% and 71.4% for patients with SUVmax between 9.5–14.5 and above 14.5, respectively. Patients with bone invasion had worse distant metastasis-free survival compared to patients without bone invasion (log-rank test, p = 0.032). In conclusion, metabolic tumor imaging using FDG-PET could be used to rule out bone invasion in oral cancer patients and may serve in treatment planning.
Highlights
Oral squamous cell carcinoma (OSCC) is an aggressive malignancy characterized by local invasiveness and high propensity to lymph node metastases [1]
From the upper and lower gum, retromolar trigone, floor of mouth, and hard palate with available pretherapeutic PET/computed tomography (CT) or PET/magnetic resonance imaging (MRI) were included in this study (Table 1)
No bone invasion bone invasion no bone invasion bone invasion no bone invasion no bone invasion bone invasion bone invasion. This retrospective study evaluates the predictability of bone invasion by fluorodeoxyglucose positron emission tomography (FDG-PET) parameters of OSCC in a cohort of 84 patients
Summary
Oral squamous cell carcinoma (OSCC) is an aggressive malignancy characterized by local invasiveness and high propensity to lymph node metastases [1]. OSCC is the sixth most common cancer worldwide and the most common site of malignancy in the head and neck [2]. The incidence of OSCC varies among geographical regions with a high incidence in Melanesia, South Central Asia, Australia, and Europe [3]. OSCC underscores the need for better prognostic tools, as recently reported in the 8th edition of American Joint Committee on Cancer staging system [4]. OSCC is primarily amenable to surgery and requires wide local excision with macroscopical margins of usually at least 1.0 cm. Wide local excision leads to a substantial defect, which has to be reconstructed with a local or free flap [5]
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