¹⁸F-FDG PET-CT in the Management of Patients Receiving Definitive Radiotherapy for Malignancies of the Head and Neck

Figure 4

85-year-old woman with squamous cell carcinoma of the left tonsil, clinical stage T1, N0, and M0, treated with IMRT with concurrent Erbitux. (a) PET-CT 16 months following completion of therapy demonstrated no evidence of local or regional recurrence of malignancy or distant metastatic disease. (b) PET-CT 23 months following completion of therapy showed hypermetabolism in the left tonsillar pillar and a left level II internal jugular lymph, subsequently biopsied with pathology showing metastatic squamous cell carcinoma. The patient was treated with reirradiation of the head/neck. (c) One year following reirradiation, PET-CT showed an enlarging, metabolically active adrenal mass with biopsy showing a poorly differentiated adenocarcinoma with mucinous and signet ring cell features, consistent with a colon cancer primary. (d) PET-CT 5 months later showed progression of the adrenal mass. The patient was also diagnosed with renal cell carcinoma, treated with cryoablation. She died of progressing malignancies, both in a neck recurrence and metastatic colon carcinoma, 13 months later following the last PET-CT, and 69 months following completion of her original IMRT for left tonsillar cancer.

(a)

(b)

(c)

(d)