Detection Of Recurrent Disease Research Articles

Abstract 2240: TERT promoter mutations are highly prevalent in bladder cancer and represent a potential new urinary biomarker

Abstract Somatic mutation of the promoter region of the telomerase reverse transcriptase (TERT) gene was recently reported as a potential mechanism by which telomerase becomes activated in cancer cells. Here, we aimed to assess the frequency and spectrum of TERT promoter mutations in bladder cancer and detect mutations in voided urine. A SNaPshot assay designed to simultaneously interrogate two positions (-124bp and -146bp) previously reported as mutated in melanoma was used to screen 47 bladder cancer cell lines and 262 tumors. Forty cell lines and 201 tumors carried mutations at either -124bp or -146bp. Mutations at these positions were mutually exclusive. A germline mutation at -57bp (T>G) was previously reported in a melanoma-prone family. A second SNaPshot assay was designed to interrogate position -57bp and we screened all samples that were wildtype at positions -124bp and -146bp. Mutations at -57bp were detected in two cell lines and eight tumors. Matched blood samples were available for six of the tumors and one cell line, and somatic mutation status was confirmed. Sanger sequencing of the TERT core promoter in samples that were wildtype at positions -57bp, -124bp and -146bp revealed a further nine somatic mutations. Four mutations at positions -45bp, -72/-77bp, -141bp, and -54bp were novel, and all but one (-54bp) created new binding sites for ETS/TCF transcription factors. Overall, TERT promoter mutations were detected in 89% of cell lines and 83% of tumors. There was no association of TERT promoter mutation status with stage (p=0.1089, chi-square test) or grade (p=0.2438, chi-square test). As mutations are highly frequent in both non-muscle-invasive and invasive bladder cancer, these represent potential biomarkers for urine-based disease monitoring. For sixty-four tumors used in this study, matched urine samples were also collected prior to surgery. Fifty-three of the tumors had mutations at -124bp or -146bp and using the -124bp/-146bp SNaPshot assay we were able to detect 51 of these in the corresponding urine samples including all mutations (n=23) in 29 patients with low-grade noninvasive tumors. The use of TERT promoter mutation analysis in combination with other DNA-based biomarkers could markedly improve the sensitivity for urine-based detection of recurrent disease. Citation Format: Carolyn D. Hurst, Fiona M. Platt, Margaret A. Knowles. TERT promoter mutations are highly prevalent in bladder cancer and represent a potential new urinary biomarker. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2240. doi:10.1158/1538-7445.AM2014-2240

Why Routine Clinical Follow-up for Patients With Early-Stage Endometrial Cancer Is Not Always Necessary

Objective This study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate. Design This study used a retrospective analysis of follow-up data. Setting This study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom. Sample This study sample is composed of 552 women. Methods Data regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ2 test, Cox proportional hazard regression analysis, and Kaplan-Meier curves. Main Outcome Measures This study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up. Results Between January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was “recurrent disease” with overall survival (hazard ratio, 2.20; P Conclusions Routine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.

The role of PET-CT in detecting disease recurrence in thyroid cancer

The role of PET-CT in detecting disease recurrence in thyroid cancer

An Anchoring and Steering Device for Wireless In Vivo Surveillance of Nasopharyngeal Carcinoma1

An Anchoring and Steering Device for Wireless In Vivo Surveillance of Nasopharyngeal Carcinoma1

11C-Hydroxyephedrine Positron Emission Tomography in the Postoperative Management of Pheochromocytoma and Paraganglioma

Aim: Accurate detection of recurrent disease and restaging are essential in the postoperative surveillance of many patients with pheochromocytomas (PHEOs) and paragangliomas (PGLs). In this study, the impact of positron emission tomography (PET) and PET/computed tomography (CT) with ¹¹C-hydroxyephedrine (HED) was evaluated for the postoperative surveillance and diagnosis of recurrent disease and for functional monitoring of locoregional and systemic therapy. Methods: One hundred and eleven HED-PET and PET/CT examinations performed in 48 patients after surgical intervention for PHEO/PGL were analyzed retrospectively. In a subgroup of 16 patients who underwent systemic and locoregional therapies, the tracer uptake in tumors was also measured as the functional volume (FV), maximum standardized uptake value (SUV_max), mean SUV (SUV_mean) and as the total catecholamine transporter tumor volume (TCTTV) calculated as TCTTV = FV × SUV_mean. The PET imaging results were correlated with CT/magnetic resonance imaging findings and biochemical and clinical follow-up data. Results: In the first postoperative examination, HED-PET was positive in 24/48 and negative in 24/48 patients with no false-positive results, yielding 92.3% sensitivity and 100% specificity. For the 16 patients, there was a significant correlation between FV and SUV_max and SUV_max and TCTTV. TCTTV correlated significantly with plasma and urinary catecholamines. In 11/16 patients, SUV_max and TCTTV increased/decreased in parallel but not in the remaining 5 patients. Conclusion: HED-PET and PET/CT were found to be valuable in the postoperative follow-up in detecting recurrent and metastatic disease. In a subgroup of patients, functional monitoring of systemic and locoregional therapies was feasible by assessing the changes of the TCTTV, and therefore warrants further prospective evaluation.

Prostate cancer: measuring PSA.

Population screening with prostate-specific antigen (PSA) for detection of prostate cancer is a topic associated with ongoing dissent and confusion within the oncology and wider medical community. The PSA blood test has been used in various stages of prostate cancer management, including screening and the assessment of future risk of prostate cancer development, detection of recurrent disease after local therapy and in the management of advanced disease. However, PSA-based decision-making in prostate cancer has significant shortcomings. This review will summarise the evidence and current recommendations for the use of PSA in detection and management of prostate cancer.

729 11C-acetate PET/CT imaging for detection of recurrent disease following radical prostatectomy or radiotherapy in patients with prostate carcinoma

729 11C-acetate PET/CT imaging for detection of recurrent disease following radical prostatectomy or radiotherapy in patients with prostate carcinoma

Why Routine Clinical Follow-up for Patients With Early Stage Endometrial Cancer Is Not Always Necessary: A Study on Women in South Wales

This study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate. This study used a retrospective analysis of follow-up data. This study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom. This study sample is composed of 552 women. Data regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ test, Cox proportional hazard regression analysis, and Kaplan-Meier curves. This study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up. Between January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was "recurrent disease" with overall survival (hazard ratio, 2.20; P < 0.001; 95% confidence interval, 1.75-2.65) and progression-free survival (hazard ratio, 2.52; P < 0.001; 95% confidence interval, 2.09-2.95). "Asymptomatic recurrence" was not an independent predictor of outcome. Routine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.

Imaging Features of Therapeutic Drug-Induced Disease: Part II

: As survival rate continues to increase for patients with childhood and adult malignancies, it is important to detect disease recurrence and to find the potential complication that occurs after treatment with oncologic medication and therapeutic radiation. The most common side effect of the anthracycline drug is its cardiotoxic effect which will give the patient a decline in ejection fraction and may result in dilated cardiomyopathy. The use of isotope scan and FDG-PET exam plays an important role in diagnosis of this subclinical cardiac dysfunction. Other less common cardiotoxic side effect of chemotherapeutic medications include: arrhythmia, myocarditis, coronary artery disease, tamponade, pericarditis, and pericardial effusion. Radiation therapy can also lead to cardiotoxicity when the heart or pericardium is included in the radiation porta. Radiation-induced conditions include: pericardial disease, coronary artery disease, valvular disease, and cardiomyopathy. Many of these side effects may remain asymptomatic until late in the course of the disease and may be detected earlier. With the use of appropriate imaging modalities, radiologists should be familiar with the current knowledge and pathophysiology of these cardiac complications.

A paradigm shift from anatomic to functional and molecular imaging in the detection of recurrent prostate cancer.

Approximately a third of men with localized prostate cancer who are treated with external beam radiation therapy (EBRT) or radical prostatectomy (RP) develop biochemical failure (BF). Presumably, BF will progress to distant metastasis and prostate cancer-specific mortality in some patients over subsequent years. Accurate detection of recurrent disease is important because it allows for appropriate treatment selection (e.g.,local vs systemic therapy) and early delivery of therapy (e.g., salvage EBRT), which affect patient outcome. In this article, we discuss the paradigm shift in imaging technology in the detection of recurrent prostate cancer. First, we discuss the commonly used morphological and anatomical imaging modalities and their role in the post-RP and post-EBRT settings of BF. Second, we discuss the accuracy of functional and molecular imaging techniques, many of which are under investigation. Further studies are needed to establish the role of imaging techniques for detection of cancer recurrence and clinical decision-making.

Biochemical evaluation of hyaluronic acid in breast cancer.

The latest experimental studies on human cancer diseases have observed the bioactive role of hyaluronic acid (HA) during carcinogenesis. HA is a component of the extra-cellular matrix (ECM). It is closely correlated with tumor cell growth, proliferation, and metastasis. The present study aimed to evaluate the biochemical role of HA and its degrading enzymes and products in breast cancer (BC) patients under therapy treatment. An ELISA method was used to determine HA levels and standard spectrophotometric techniques were used to estimate the activities of HA degrading enzymes hyaluronidase (HAS), N-acetyl-beta-D-glucosminidase (NAG), and beta-glucuronidase (beta-Glu) and the concentration of both glucoseamine (G-Amine) and glucuronic acid (GA) as degrading products in blood sera of 50 BC patients before and after chemotherapy treatment and in blood sera of 40 healthy women as controls. Statistical analyses were performed by a statistical package for social sciences (SPSS, version 15.0). Elevated serum HA levels, increased HAS, NAG, and beta-Glu activities and high concentrations of G-Amine and GA were significantly found (p < 0.001) in patients before treatment compared to controls. After all BC patients had received the first chemotherapy course, HA and its previous degrading parameters were significantly decreased (p < 0.001) in post-treated patients compared to pre-treated patients. Hyaluronic acid and its degrading enzymes and products can be considered a biomarker for early detection of recurrent disease and also for monitoring the effective therapeutic follow up of BC patients.

Abstract P2-06-01: cMethDNA is a quantitative circulating methylated DNA assay for detection of metastatic breast cancer and for monitoring response to therapy

Abstract Background- The ability to consistently detect cell-free tumor-specific DNA in peripheral blood of patients with metastatic breast cancer provides the opportunity to detect changes in tumor burden and to monitor response to treatment. Studies of cell-free DNA in the peripheral blood of breast cancer patients suggest that methylated DNA markers in serum or plasma could be used for detection of advanced disease, monitoring of therapeutic response, and for early detection of disease recurrence. Methods- A genome-wide serum DNA methylome array (Illumina HumanMethylation27 BeadChip) analysis was conducted on cell-free circulating DNA in serum from women with stage IV recurrent breast cancer, and 232 key CpG loci were identified. Methylation for this panel of 10 gene loci was evaluated using our newly developed cMethDNA assay to detect miniscule amounts of methylated DNA in Training and Test sets of sera from a total of 112 women (n = 55 normal, n = 57 metastatic breast cancer). The clinical sensitivity and specificity of the assay, along with technical reproducibility, was determined. To evaluate the concordance of DNA methylation patterns, the 10 gene panel was tested on 22 DNA sets of primary tumor, metastases and serum from the same patient. Finally, the ability of cMethDNA to monitor response to therapy was evaluated in 28 patients with metastatic disease. Results- A normal laboratory threshold of 7 cumulative methylation units was set and assay parameters were locked, based on Receiver Operating Characteristic (ROC) analyses of DNA from 300 ul of patient sera in the Training set (normal, n = 28; cancer, n = 24; 92% sensitivity, 96% specificity, and AUC = 0.950). Evaluation of the Test set of patient sera (normal, n = 27; cancer n = 33) resulted in detection of metastatic breast cancer with 91% sensitivity, 100% specificity, and AUC = 0.994 (0.984-1.005, p&amp;lt;0.0001). Reproducibility of the cMethDNA assay increased with copy number; with the highest variation at 50 copies (CV = 29.1%) and the lowest at 3,200 copies (CV = 2.5%) of methylated DNA. The test was shown to be operator independent (ICC = 0.99). Evaluation of concordance between primary and disseminated tumor methylation showed that the methylation pattern from any given individual is highly conserved between serum, primary tissue and their metastases, and poorly conserved between different individuals. cMethDNA analysis of 28 patients before and after initiation of therapy showed a decrease in cumulative methylation in women with stable/responsive disease and a correlation with disease progression free survival (p&amp;lt;0.0001). Conclusion- Together, our data suggest that the cMethDNA test 1) can detect tumor DNA shed into blood, 2) reflect the methylation alterations typical of the primary tumor and its metastatic lesions, and 3) reflect response to treatment after chemotherapy. Next, we will test the clinical utility of cMethDNA in independent clinical trial sample sets where it's complementary and independent roles will be examined against CA15.3 and CTC assays. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-06-01.

Intensity of Follow-Up After Melanoma Surgery

This contemporary review of melanoma surveillance strategies seeks to help practitioners examine and improve their surveillance protocols based on the currently available data. In general, there is no definitive benefit from increased screening or more aggressive use of interval imaging. Low-intensity surveillance strategies do not appear to adversely affect patient outcomes and should be the preferred approach compared with high-intensity strategies for most melanoma patients. All surveillance programs should emphasize education in order to maximize the effectiveness of patient-based detection of recurrent disease.

Cardiac Complications of Oncologic Therapy

As survival rates continue to increase for patients with childhood and adult malignancies, imaging utilization in these patients will likely increase substantially. It is important to detect disease recurrence and to recognize the potential complications that occur after treatment with oncologic medications and therapeutic radiation. The most common cardiotoxic side effect of the anthracycline drug class is a dose-dependent decline in ejection fraction, which may result in dilated cardiomyopathy. Multiple-uptake gated acquisition (MUGA) scanning plays an important role in diagnosis of this subclinical cardiac dysfunction. Other less common cardiotoxic side effects of chemotherapeutic medications include arrhythmia, myocarditis, coronary artery disease, tamponade, pericarditis, and pericardial effusion. Radiation therapy can also lead to cardiotoxicity when the heart or pericardium is included in the radiation portal. Radiation-induced conditions include pericardial disease, coronary artery disease, valvular disease, and cardiomyopathy. Many of these side effects are asymptomatic until late in the course of the disease. With imaging, these pathologic conditions can often be diagnosed before symptom onset, which may allow early intervention. Radiologists should be familiar with the current knowledge and pathophysiology regarding cardiac complications related to chemotherapy and radiation therapy of malignant neoplasms and the appearances of treatment-related cardiotoxicity that can be found at radiography, nuclear medicine examinations, and cross-sectional imaging. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.336125005/-/DC1.

Early Detection of Recurrent Disease by FDG-PET/CT Leads to Management Changes in Patients With Squamous Cell Cancer of the Head and Neck

The objective of this study was to compare the efficacy of surveillance high-resolution computed tomography (HRCT) and physical examination/endoscopy (PE/E) with the efficacy of fluorodeoxyglucose (FDG)-positron emission tomography (PET)/HRCT for the detection of relapse in head and neck squamous cell carcinoma (HNSCC) after primary treatment. This is a retrospective analysis of contemporaneously performed FDG-PET/HRCT, neck HRCT, and PE/E in 99 curatively treated patients with HNSCC during post-therapy surveillance to compare performance test characteristics in the detection of early recurrence or second primary cancer. Relapse occurred in 19 of 99 patients (20%) during a median follow-up of 21 months (range: 9-52 months). Median time to first PET/HRCT was 3.5 months. The median time to radiological recurrence was 6 months (range: 2.3-32 months). FDG-PET/HRCT detected more disease recurrences or second primary cancers and did so earlier than HRCT or PE/E. The sensitivity, specificity, and positive and negative predictive values for detecting locoregional and distant recurrence or second primary cancer were 100%, 87.3%, 56.5%, and 100%, respectively, for PET/HRCT versus 61.5%, 94.9%, 66.7%, and 93.8%, respectively, for HRCT versus 23.1%, 98.7%, 75%, and 88.6%, respectively, for PE/E. In 19 patients with true positive PET/HRCT findings, a significant change in the management of disease occurred, prompting either salvage or systemic therapy. Of the 14 curatively treated patients, 11 were alive with without disease at a median follow-up of 31.5 months. FDG-PET/HRCT has a high sensitivity in the early detection of relapse or second primary cancer in patients with HNSCC, with significant management implications. Given improvements in therapy and changes in HNSCC biology, appropriate modifications in current post-therapy surveillance may be required to determine effective salvage or definitive therapies.

Impact of Physical Activity After Cancer Diagnosis on Survival in Patients With Recurrent Colon Cancer: Findings From CALGB 89803/Alliance

BackgroundThe impact of physical activity on survival outcomes in patients with recurrent colon cancer has not been studied. We tested the association between the level of postdiagnosis physical activity and survival outcomes of patients with recurrent colon cancer. Patients and MethodsWe conducted a prospective observational study of 237 patients with stage III colon cancer who had recurrence of disease. Physical activity was measured approximately 6 months after the completion of therapy (14 months after surgical resection) but before detection of recurrent disease. The primary end point of the study was survival time after recurrence. ResultsThe hazard ratio comparing patients who reported at least 18 metabolic equivalent task (MET) hours per week of physical activity with those engaging in < 3 MET hours per week was 0.71 (95% confidence interval, 0.46-1.11). Increasing total MET hours of physical activity per week was associated with a borderline statistical significance trend for improved survival after recurrence (P = .052). The benefit of physical activity on survival was not significantly modified by sex, body mass index (BMI), number of positive lymph nodes, age, baseline performance status, adjuvant chemotherapy regimen, or recurrence-free survival period. ConclusionTo our knowledge, this is the first study investigating the association of physical activity with survival outcome of patients with recurrent colon cancer. Although the association exceeded our predefined P trend < .05 for statistical significance, these findings warrant further studies of physical activity in patients with recurrent colorectal cancer.

PET‐CT and the detection of the asymptomatic recurrence or second primary lesions in the treated head and neck cancer patient

The role of follow-up and the detection of recurrent or new primary disease in cancer management remains to be defined. Specifically, the effectiveness and impact on survival of imaging studies that detects disease before it is symptomatic or noted on exam is unknown. Retrospective chart review. A retrospective review was performed on a series of head and neck cancer patients (n = 123), at a single institution from February 18, 2004 to July 9, 2007, who had undergone nonstaging 18F-fluorodeoxyglucose positron emission tomography-computing tomography (FDG PET-CT) scans as an integral part of the patient's follow-up after definitive treatment. Each scan (n = 308) was evaluated by a board-certified nuclear medicine physician, and final scan readings from each patient's medical record were reviewed for this study. Of the 123 patients in the study, 24 (20%) were noted to have asymptomatic lesions (either recurrent or new primaries) indicated on PET/CT (8% of surveillance scans) at an average interval of 35.7 weeks posttreatment. Asymptomatic lesions were detected most frequently at distant sites, with 50% being thoracic, but also included were primary (9%), regional (9%), and other distant (32%) sites. At last follow-up of the 24 patients in whom an asymptomatic lesion was detected, 14 patients have died of disease; 10 patients remain alive, four with disease; and one patient had a subsequent recurrence treated and is currently disease-free. PET-CT scanning is an effective tool for detecting asymptomatic disease in patients previously treated for head and neck cancer. Unfortunately, even with early detection of recurrent disease, the mortality rate remains high.

Endoscopic Management of Intraluminal Ureteral Endometriosis

To present the largest experience on the ureteroscopic management of ureteral obstruction secondary to intraluminal endometrial implantation. We retrospectively evaluated patients who underwent ureteroscopic management of intraluminal endometriosis from 1996 to 2012. All patients were diagnosed with ureteroscopic biopsy and underwent at least 1 ureteroscopic ablation with a holmium YAG (Ho:Yag) laser. Patients were monitored for evidence of disease persistence, recurrence, or progression with computed tomography, sonography, renal scan, ureteroscopy, and retrograde urography. Success was defined as the complete eradication of ureteral endometriosis, resolution of symptoms, and maintenance of renal function. Five patients were identified. Mean age was 37.5 years. All patients had hydroureteronephrosis at presentation whereas 2 had severely impaired renal function. Three patients were successfully treated with a single ablative procedure, whereas 2 had persistent symptomatic hydroureteronephrosis and underwent repeat ablation. Of those requiring repeat ablation, 1 became disease-free after the second ablation, whereas the other had persistence of disease, requiring nephroureterectomy. Three patients developed ureteral strictures, requiring balloon dilation and serial stent exchanges. At a median follow-up of 35 months (16-84), overall success rate was observed in 4 of 5 patients (80%). Endometriosis affects approximately 15% of premenopausal women and can present anywhere along the urinary tract including the ureters, which might result in urinary obstruction and impaired renal function. Although surgical resection is the conventional treatment option for intraluminal endometriosis, ureteroscopic management is a viable nephron-sparing alternative. Follow-up imaging, including ureteroscopic surveillance and retrograde urography is recommended to detect disease recurrence or progression, or both.

Current management options for recurrent adrenocortical carcinoma

Adrenal cortical carcinoma (ACC) is a rare cancer that poses a number of management challenges due to the limited number of effective systemic treatments. Complete surgical resection offers the best chance of long-term survival. However, despite complete resection, ACC is associated with high recurrence rates. This review will discuss the management of recurrent ACC in adults following complete surgical resection. Management should take place in a specialist center and treatment decisions must consider the individual tumor biology of each case of recurrence. Given the fact that ACC commonly recurs, management to prevent recurrence should be considered from initial diagnosis with the use of adjuvant mitotane. Close follow up with clinical examination and imaging is important for early detection of recurrent disease. Locoregional recurrence may be isolated, and repeat surgical resection should be considered along with mitotane. The use of radiotherapy in ACC remains controversial. Systemic recurrence most often involves liver, pulmonary, and bone metastasis and is usually managed with mitotane, with or without combination chemotherapy. There is a limited role for surgical resection in systemic recurrence in selected patients. In all patients with recurrent disease, control of excessive hormone production is an important part of management. Despite intensive management of recurrent ACC, treatment failure is common and the use of clinical trials and novel treatment is an important part of management.

Effect of early detection of recurrent disease by FDG PET/CT on management of patients with squamous cell cancer of the head and neck (HNSCC).

6062 Background: Despite the increasing cure rates a substantial fraction of HNSCC patients (pts) will present with locoregional and/or distant relapse within 3 years of definitive therapy. The prognosis of HNSCC pts after failure of first-line therapy has been poor but recent changes in the biology of HNSCC, advances in surgical techniques and radiotherapy; and new drugs may lead to improved salvage therapy. Notably, the success of these developments are implicitly dependent on early diagnosis disease. Our objective was to compare the efficacy of surveillance FDG-PET/CT to that of high resolution CT (HRCT) and physical exam (PE/E) for detection of early relapse in HNSCC after completion of primary treatment. Methods: A retrospective analysis of FDG-PET/CT, neck HRCT and PE/E was performed in 99 curatively treated HNSCC pts during post-therapy surveillance (PTS) to compare the performance characteristics of the tests in the detection of early recurrence or metachronous cancer. Results: A total of 19/99 (20%) pts had recurrence during a median follow-up of 21mo (range:9-52). Median time to first PET/CT was 3.5mo. The median time to radiological recurrence was 6 mo (range:2.3-32). PET/CT detected more disease recurrences or second primaries and did so earlier than HRCT and PE/E. Sensitivity, specificity, PPVand NPV for detecting locoregional and distant recurrence or metachronous cancer : 100%, 87.3%, 56.5% and 100% for PET/CT vs. 61.5%, 94.9%, 66.7% and 93.8% for HRCT vs. 23.1%, 98.7%, 75% and 88.6% for PE/E. In all 19 pts with a true positive PET/CT there was a significant management change prompting either salvage or definitive surgery or initiation of systemic therapy. Of the 14 recurrent pts treated with curative intent, 11 were alive with no evidence of disease at a median follow up of 31.5 mo. Conclusions: FDG-PET/CT has a high sensitivity in the early detection of relapse or second primary cancer in HNSCC, associated with significant management implications. Given improvements in therapy and changes in HNSSC biology, appropriate modifications in the current recommended algorithms of the NCCN for PTS may be required to engage effective salvage or definitive therapies.