DOI: 10.1007/s00259-016-3612-1Pages: 1-10

Post-treatment PET/CT and p16 status for predicting treatment outcomes in locally advanced head and neck cancer after definitive radiation

1. Case Western Reserve University and University Hospitals, Department of Radiation Oncology

2. University Hospitals, Department of Otolaryngology and Head and Neck Surgery

3. University Hospitals, Department of Medical Oncology

4. University Hospitals, Department of Pathology

5. University Hospitals, Department of Nuclear Medicine and Radiology

Correspondence to:
Musaddiq J. Awan
Tel: 216-286-3900




To retrospectively review post-treatment (post-tx) FDG-PET/CT scans in patients with advanced head and neck squamous cell carcinoma (HNSCC) and known p16 status, treated with definitive (chemo)radiation (RT).


A total of 108 eligible patients had N2A or greater HNSCC treated with chemoRT from August 1, 2008, to February 28, 2015, with post-tx PET/CT within 6 months after RT. Kaplan–Meier curves, log-rank statistics, and Cox proportional hazards regression were used for statistical analysis.


Median follow-up was 2.38 years. Sixty-eight (63.0%) patients had p16+ and 40 (37.0%) had p16− status. Two-year overall survival and recurrence-free survival were 93.4% and 77.8%, respectively. The negative predictive value (NPV) of PET/CT for local recurrence (LR) was 100%. The NPV for regional recurrence (RR) was 96.5% for all patients, 100% for p16+ patients, and 88.5% for p16− patients. The positive predictive value (PPV) of PET/CT for recurrence was 77.3% for all patients, 50.0% for p16+, and 78.6% for p16−. The PPV for LR was 72.7% for all patients, 50.0% for p16+ patients, and 72.7% for p16− patients. The PPV for RR was 50.0% for all patients, 33% for p16+, and 66.6% for p16−. Post-tx PET/CT and p16 status were independent predictors of recurrence-free survival (p < 0.01).


Post-tx PET/CT predicts treatment outcomes in both p16 + and p16− patients, and does so independently of p16 status. P16− patients with negative PET have a 10% risk of nodal recurrence, and closer follow-up in these patients is warranted.

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  • Accepted: Dec 28, 2016
  • Online: Jan 14, 2017

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