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23:03 CET
E³ 126b - Functional imaging in head and neck oncology
Head and Neck Oncologic Imaging
Wednesday, February 27, 08:30 - 10:00
Room: M 5
Type of session: E³ - ECR Master Class
Topic: Head and Neck, Oncologic Imaging
Moderator: F. Bidault (Villejuif/FR)

Chairperson's introduction
F. Bidault; Villejuif/FR
Learning Objectives

1. To discuss the role of functional imaging in tumour staging.
2. To learn about the presentation and prognosis of head and neck cancer patients.
3. To understand the clinical impact of imaging findings.


Squamous cell carcinoma of the head and neck is one of the most common cancers worldwide. Advanced tumours are associated with high morbidity and mortality rate. Risk factors are tobacco, alcohol, wood dust (professional disease), and viral infections (EBV, HPV). A multidisciplinary team approach is required to undertake effective personalised care planning. Decision process requires understanding patient's wish, conducting a physical examination, making imaging examination, panendoscopy, tumour biopsy with a pathological result, checking the patient’s suitability for surgery. Imaging is the extension of physical examination and definitely is of tremendous importance for decision making. Speakers of this master session are leading experts in the field of imaging for locoregional tumour assessment with M.G. Mack, from Munich, incidence and prognosis of synchronous cancer or distant metastases from head and neck tumours with A.D. King, from Hong Kong, and question of the need for functional imaging to detect distant metastases with R. Maroldi, from Brescia.

A. Functional imaging for locoregional tumour assessment
M. G. Mack; Munich/DE
Learning Objectives

1. To learn about functional imaging (perfusion, DWI, PET) in head and neck cancer patients.
2. To understand the value of functional imaging for tumour assessment.
3. To discuss nodal assessment in head and neck cancer.


Head and neck cancer is one of the most common cancers worldwide. MRI based diffusion and perfusion techniques enable the non-invasive assessment of tumour biology and physiology and add additional information to standard structural MRI scans. Head and neck squamous cell carcinoma may cause a decreased apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DW MRI) and an increased standardised uptake value (SUV) on fluorodeoxyglucose (FDG) positron emission tomography (PET/CT). These techniques can improve the initial staging and can help to monitor treatment response. In addition, these techniques can improve patient selection for therapeutic strategies and provide evidence for a change of therapy regime. This presentation summarizes recent literature and provides an overview of the various studies in which diffusion or perfusion-based MRI studies are applied to head and neck cancer and will provide an overview of commonly used acquisition protocols and postprocessing methods, followed by advanced data analysis, imaging findings regarding tumour characterization and differentiation, tumour risk stratification and staging, monitoring and prediction of treatment response. Limitations will be highlighted followed by a conclusion with recommendations for the future.

B. Incidence and prognosis of synchronous cancer or distant metastases from head and neck tumours
A. D. King; Hong Kong/CN
Learning Objectives

1. To become familiar with the incidence of the synchronous tumours in the head and neck population.
2. To become familiar with the incidence of the distant metastases in the patients with newly diagnosed head and neck cancer.
3. To understand the consequences in a prognosis.


Second primary tumours Head & neck cancer has one of the highest associations with second primary tumours (SPT). SCC is associated with smoking and high alcohol intake, and so patients are also at risk of SPTs in other sites of the head & neck, lung and oesophagus. Less commonly SPTs arise in the colon, pancreas and bladder. SPTs are usually metachronous with synchronous tumours being diagnosed in only ~ 4% of patients. SPTs are a leading cause of death in patients with early-stage SCC, but SPTs detected early are potentially curable. Distant metastases With advances in locoregional control distant metastases (DM) now are emerging as a major determinant of survival. Therefore, a more active approach is being taken to detect and manage distant site disease, including the use of a new generation of immunotherapy agents. The incidence, risk factors, sites, prognosis, and management of DM vary with histology and will be discussed in three main groups comprising carcinomas of the aerodigestive tract, thyroid and salivary glands. Most DM manifest after initial treatment, the most common sites being lung or bone, followed by the liver. Prognosis tends to be poor with most patients succumbing to disease within a year. However, the prognosis is dependent on many factors which include histology, site and number of DM. Notably, some patients survive, and there is a subgroup of patients with oligometastases who have a potentially curable disease.

C. Is functional imaging necessary to detect distant metastases in head and neck cancers?
R. Maroldi; Brescia/IT
Learning Objectives

1. To review the advanced imaging for detection of distant metastases of head and neck cancer.
2. To understand the advantages and disadvantages of functional imaging modalities for M staging.
3. To discuss when to image for distant metastases.


Head and neck squamous cell carcinoma (HNSCC) is a predominantly locoregional disease. The reported incidence of distant metastasis (DM) varies in a wide range, between 3% and 50%, reflecting heterogeneity in population characteristics disease stages included, timing of diagnosis of DM, etc. DM factors do not only influence prognosis, but it is a major determinant of the choice of treatment. Patients with known DM can possibly be spared the toxicities of aggressive and often unnecessary locoregional therapy. FdG-PET-CT is the most used imaging techniques for detecting DM in HNSCC. Because the sensitivity for lesions with size less than 10mm is poor, the negative predictive value is considered insufficient for a low-volume disease. In fact, if the follow-up window increases from 12 to 30 months, the sensitivity of Fdg-PET-CT decreases from 83-97% to 60-82%, probably because of metastases too small for the technique. False positive findings are an additional troublesome factor, as the imply increased costs and delay of treatment. Therefore, FdG-PET-CT has a diagnostic yield low in early-stage disease. The highest clinical value is obtained in the pretreatment evaluation of advanced-stage (III/IV) and recurrent HNSCC. A new oncologic perspective has been recently explored: the concept of treating oligometastases (metastasectomy or stereotactic body radiotherapy). If the locoregional disease is controlled/resected, and the distant sites ablated, a prolonged disease-free interval and possible cure may be achieved. In addition to Fdg-PET-CT, a growing body of evidence has been published in the recent literature, supporting Whole-Body MRas screening for DM.

Panel discussion: How to stage head and neck tumours correctly
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