Recurrent head and neck cancer forces one binary decision: salvageable, or systemic? The standard workup answers it with a chest CT. A 500-patient series from Tata Memorial suggests that's looking in the wrong place first, bone, not lung, was the commonest site of distant spread, and one patient in ten had metastases a neck and chest CT could not see.
Full description
Episode 22. Krishnakumar Thankappan reviews Prakash, Purandare and colleagues on FDG PET/CT for restaging recurrent head and neck carcinoma, published ahead of print in the Indian Journal of Nuclear Medicine on 17 August 2026.
Five hundred patients with histopathologically proven recurrent HNSCC, restaged with PET/CT between 2010 and 2018. Distant metastases were found in 28.8%. Ninety-eight patients had extrathoracic disease; 54, 10.8% of the cohort, had extrathoracic metastases with nothing in the chest at all, and management changed in every one of them.
The episode also takes the reported 100% sensitivity apart. Only 8 of those 54 cases had histopathological confirmation; the rest were adjudicated by follow-up imaging or by an MDT that had the PET in front of it. Plus what actually predicts distant spread on multivariate analysis, why SUVmax is useless for triage, and how a 2018 data cutoff changes what the finding now means.
Chapters
- 0:06 — Opening
- 0:37 — The clinical question
- 1:40 — Study design and cohort
- 2:28 — Results: 28.8%, and bone ahead of lung
- 4:06 — What this does not show
- 5:32 — Who to refer for PET/CT
- 6:53 — Limitations
- 7:35 — Bottom line
Numbers from the episode
144/500 (28.8%) with distant metastases · 54 (10.8%) extrathoracic only · skeletal 34% vs lung 30% · recurrent stage IV, OR 2.06 (1.29–3.29) · shorter DFI, OR 0.92 (0.87–0.98) · optimal DFI cut-off 10 months · SUVmax AUC 0.61
Paper
Prakash A, Purandare NC, Shah S, Puranik AD, Agrawal A, Pantvaidya G, et al. Utility of FDG PET/CT in Restaging and Detection of Distant Metastases in Recurrent Head and Neck Carcinoma. Indian J Nucl Med. doi: 10.25259/IJNM_71_2026
Music: "Podcast Intro / Opening Talk Show" by Alex Morgan (Pixabay).
Numbers from the episode
144/500 (28.8%) with distant metastases · 54 (10.8%) extrathoracic only · skeletal 34% vs lung 30% · recurrent stage IV, OR 2.06 (1.29–3.29) · shorter DFI, OR 0.92 (0.87–0.98) · optimal DFI cut-off 10 months · SUVmax AUC 0.61
Paper
Prakash A, Purandare NC, Shah S, Puranik AD, Agrawal A, Pantvaidya G, et al. Utility of FDG PET/CT in Restaging and Detection of Distant Metastases in Recurrent Head and Neck Carcinoma. Indian J Nucl Med. doi: 10.25259/IJNM_71_2026
Music: "Podcast Intro / Opening Talk Show" by Alex Morgan (Pixabay).
