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Cox et al. J Cancer Metastasis Treat 2021;7:25 Journal of Cancer
DOI: 10.20517/2394-4722.2021.55
Metastasis and Treatment

Review Open Access

18 F-FDG-PET/CT-guided radiotherapy of cervical
lymph nodes in head and neck squamous cell

carcinoma

Maurice C. Cox, Sven van den Bosch, Tim Dijkema, Johannes H.A.M. Kaanders
Department of Radiation Oncology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands.
Correspondence to: Dr. Maurice C. Cox, MD, Department of Radiation Oncology, Radboud University Medical Center (route
874), Geert Grooteplein 32, 6525 GA Nijmegen, the Netherlands. E-mail: maurice.cc.cox@radboudumc.nl
18
How to cite this article: Cox MC, van den Bosch S, Dijkema T, Kaanders JHAM. F-FDG-PET/CT-guided radiotherapy of cervical
lymph nodes in head and neck squamous cell carcinoma. J Cancer Metastasis Treat 2021;7:25.
https://dx.doi.org/10.20517/2394-4722.2021.55

Received: 3 Mar 2021 First Decision: 8 Apr 2021 Revised: 16 Apr 2021 Accepted: 21 Apr 2021 Published: 8 May 2021

Academic Editor: Lucio Miele Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
The use of positron emission tomography with fluor-18-fluorodeoxyglucose (FDG-PET) in clinical practice for
patients with head and neck squamous cell carcinoma (HNSCC) has expanded rapidly, with implications for
diagnostic staging, radiotherapy planning, adaptive radiotherapy, and post-therapy evaluation. The implementation
of FDG-PET/CT in radiation treatment planning not only has consequences for target volume definition and dose
prescription but is also associated with an increased overall survival in patients with HNSCC. FDG-PET/CT-guided
gradient dose prescription provides a window of opportunity for treatment de-intensification of the neck in order to
decrease treatment-related toxicity without compromising oncological outcome. Further, interim FDG-PET/CT
during radiotherapy can be useful to assess metabolic tumor response and enables opportunities for adaptive
treatment strategies. The goals are to increase treatment effectivity in poor responders and reduce unnecessary
toxicity in patients with good early tumor response. Further prospective trials investigating adaptive radiotherapy
based on interim PET-evaluation are needed, especially regarding human papilloma virus-negative HNSCC and
patients treated with primary radiotherapy.

Keywords: Head and neck cancer, radiotherapy, FDG-PET, imaging, nodal metastases

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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