18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer | Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

array:24 ["pii" => "S225380891830079X" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.08.003" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1013" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:154-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 7 "formatos" => array:2 [ "HTML" => 3 "PDF" => 4 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2253654X18300520" "issn" => "2253654X" "doi" => "10.1016/j.remn.2018.08.002" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1013" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:154-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 476 "formatos" => array:2 [ "HTML" => 428 "PDF" => 48 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "18F-FDG PET/TC para la estadificación y la delineación del volumen de radioterapia en el cáncer de cabeza y cuello" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "154" "paginaFinal" => "159" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1489 "Ancho" => 2500 "Tamanyo" => 114681 ] ] "descripcion" => array:1 [ "es" => "Estudio TC (A) de un paciente con un carcinoma de hipofaringe cT3N0. La PET/TC (B) muestra ganglios linfáticos subcentimétricos en el espacio retrofaríngeo izquierdo (SUVmáx=13,99) y el nivel IIA izquierdo (SUVmáx=11,19). Estadio final: cT3N2bM0, IVA." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Pedraza, A. Ruiz-Alonso, A.C. Hernández-Martínez, E. Cabello, D. Lora, J.F. Pérez-Regadera" "autores" => array:6 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Pedraza" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Ruiz-Alonso" ] 2 => array:2 [ "nombre" => "A.C." "apellidos" => "Hernández-Martínez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Cabello" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Lora" ] 5 => array:2 [ "nombre" => "J.F." "apellidos" => "Pérez-Regadera" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S225380891830079X" "doi" => "10.1016/j.remnie.2018.08.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380891830079X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18300520?idApp=UINPBA00004N" "url" => "/2253654X/0000003800000003/v2_202009160717/S2253654X18300520/v2_202009160717/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2253808919300138" "issn" => "22538089" "doi" => "10.1016/j.remnie.2019.01.005" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1043" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:160-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Association between white matter lesions and cerebral glucose metabolism in patients with cognitive impairment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "160" "paginaFinal" => "166" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación entre daños en la sustancia blanca y metabolismo de la glucosa cerebral en pacientes con disfunción cognitiva" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1109 "Ancho" => 2022 "Tamanyo" => 149170 ] ] "descripcion" => array:1 [ "en" => "Flow diagram of the study population." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hyun-Jung No, Hyon-Ah Yi, Kyoung Sook Won, Hyuk Won Chang, Hae Won Kim" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Hyun-Jung" "apellidos" => "No" ] 1 => array:2 [ "nombre" => "Hyon-Ah" "apellidos" => "Yi" ] 2 => array:2 [ "nombre" => "Kyoung Sook" "apellidos" => "Won" ] 3 => array:2 [ "nombre" => "Hyuk Won" "apellidos" => "Chang" ] 4 => array:2 [ "nombre" => "Hae Won" "apellidos" => "Kim" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18302294" "doi" => "10.1016/j.remn.2018.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18302294?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300138?idApp=UINPBA00004N" "url" => "/22538089/0000003800000003/v1_201905020850/S2253808919300138/v1_201905020850/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808919300011" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.11.009" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1044" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:147-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Diagnostic impact of 18F-FDG PET/CT on the management of rare breast carcinomas: apocrine and neuroendocrine carcinomas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "147" "paginaFinal" => "153" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto diagnóstico de la 18F-FDG en el tratamiento de carcinomas de mama raros: carcinomas apocrinos y neuroendocrinos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 778 "Ancho" => 2167 "Tamanyo" => 144986 ] ] "descripcion" => array:1 [ "en" => "PET, CT, fusion (F) sections, and maximum intensity projection (MIP) image of a 43-year-old female patient with Luminal B type apocrine cancer in the lower-outer quadrant of right breast. Size of the primary tumor: 2.5cm, SUVmax: 10.6 (black and white arrows). Short axis diameter of metastatic axillary lymph node:0.8cm, SUVmax: 9.2 (dashed black and white arrows)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esra Arslan, Tevfik Fikret Çermik, Fadime Didem Can Trabulus, Esra Canan Kelten Talu, Şerife Başaran" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Esra" "apellidos" => "Arslan" ] 1 => array:2 [ "nombre" => "Tevfik Fikret" "apellidos" => "Çermik" ] 2 => array:2 [ "nombre" => "Fadime Didem" "apellidos" => "Can Trabulus" ] 3 => array:2 [ "nombre" => "Esra Canan" "apellidos" => "Kelten Talu" ] 4 => array:2 [ "nombre" => "Şerife" "apellidos" => "Başaran" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18301975" "doi" => "10.1016/j.remn.2018.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18301975?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300011?idApp=UINPBA00004N" "url" => "/22538089/0000003800000003/v1_201905020850/S2253808919300011/v1_201905020850/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "154" "paginaFinal" => "159" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sara Pedraza, Ana Ruiz-Alonso, Ana Cristina Hernández-Martínez, Eduardo Cabello, David Lora, José Fermín Pérez-Regadera" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Sara" "apellidos" => "Pedraza" "email" => array:1 [ 0 => "s.pedraza87@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana" "apellidos" => "Ruiz-Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ana Cristina" "apellidos" => "Hernández-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Cabello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "David" "apellidos" => "Lora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "José Fermín" "apellidos" => "Pérez-Regadera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Radiation Oncology, University Hospital 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Nuclear Medicine, University Hospital 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Clinical Epidemiology Unit, CIBERESP, University Hospital 12 de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "18F-FDG PET/TC para la estadificación y delineación del volumen de radioterapia en el cáncer de cabeza y cuello" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Image 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1489 "Ancho" => 2500 "Tamanyo" => 114681 ] ] "descripcion" => array:1 [ "en" => "CT scan (A) from a patient with a cT3N0 hypofarynx carcinoma. PET-CT show subcentimeter lymph nodes in left retropharynx level (SUVmax=13.99) and left IIA level (SUVmax=11.19). Final stage: cT3N2bM0, IVA." ] ] ] "textoCompleto" => "IntroductionHead and neck cancer (HNC) refers to a heterogeneous group formed by paranasal sinuses, oral cavity, nasopharynx, oropharynx, hypopharynx and larynx tumors. In these tumors, radiotherapy (RT) has long played an important role providing its main advantage: organ-preservation. From the 1990s, intensity-modulated radiation therapy (IMRT) has revolutionized RT treatment. This technique, which achieves better dose conformity to the treatment volume while sparing organs at risk, has been shown to be useful in HNC treatment planning.<a class="elsevierStyleCrossRef" href="#bib0155">1</a>However, this modern RT requires precise volume delineation.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> Traditionally, head and neck (HN) CT has been the gold standard image technique for staging and RT treatment planning.<a class="elsevierStyleCrossRef" href="#bib0165">3</a> HN-MRI provides complementary information on soft tissue involvement and nodal disease, particularly for the oral cavity, salivary glands and nasopharynx, but due to logistic problems when image co-registration is performed, it is not widely used in RT planning.<a class="elsevierStyleCrossRef" href="#bib0170">4</a> Visual evaluation of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (18F-FDG) is superior to CT in identifying the tumor extension and nodal disease<a class="elsevierStyleCrossRefs" href="#bib0175">5–8</a> in patients with HNC. In addition, unsuspected distant disease and synchronous tumors can also be identified.<a class="elsevierStyleCrossRef" href="#bib0195">9</a> Several authors and guidelines, including the International Atomic Energy Agency (IAEA) or the National Comprehensive Cancer Network (NCCN), have already investigated the role of 18F-FDG PET integrated with CT (18F-FDG PET/CT) in staging and delineation of the primary head and neck tumor and lymph node metastases in HNC.<a class="elsevierStyleCrossRefs" href="#bib0155">1,10–13</a>The aim of this study is to explore the potential impact of 18F-FDG PET/CT in HNC through our clinical daily practice. We investigated its effect on the initial staging and we analyzed if a variation in staging, alters the therapeutic strategy and therefore RT treatment planning.Methods and materialsStudy designIn this cohort study, consecutive patients with untreated primary HNC were enrolled between June 2009 and January 2014. Initially, all patients were staged according to the AJCC staging classification<a class="elsevierStyleCrossRef" href="#bib0220">14</a> by performing a physical examination, fiber-endoscopy if needed, HN-CT and chest radiography. All patients underwent a whole-body 18F-FDG PET/CT for staging and also for delineation RT volumes. Staging based on 18F-FDG PET/CT information was compared with the classical staging based on HN-CT to detect differences. The impact on patient management was determined by comparing the therapeutic management before and after 18F-FDG PET/CT was performed.Age variable is presented as mean and range. Categorical variables are presented as absolute and relative frequencies. Risk stratification tables<a class="elsevierStyleCrossRefs" href="#bib0225">15,16</a> were used to evaluate the benefit of using 18F-FDG PET/CT information versus HN-CT.No formal ethics committee approval was required for this analysis of a routine clinical service.CT and 18F-FDG PET/CT image acquisition and interpretationHN-CT was performed at the Radiology Service by using a Phillips® Brilliance Ict scan. Neck CT images were obtained from the base of the skull to the carina, under quiet breathing, with a 3mm reconstruction. Intravenous contrast was injected unless reported allergy or contraindication. An experienced radiologist interpreted the images.18F-FDG PET/CT scan was done at the Department of Nuclear Medicine by using our standard procedure. Patients were instructed to fast for at least 6hours before 18F-FDG PET/CT. Blood glucose level before the injection of 18F-FDG (5 MBq/Kg; 250-450 MBq) was measured to confirm it was lower than 200mg/dl. Images were taken 60±10min after injection, using a hybrid PET-CT SIEMENS® Biograph True Point. Acquisition time was 3min/bed or 4min if patient body mass index ≥30. Images were reconstructed with a slice thickness of 5mm. Immediately before CT was acquired, intravenous contrast was administered if no contraindications were present. CT data were used for attenuation correction and anatomic localization. Since 2012 onwards, a selective 18F-FDG PET/CT of HN region with intravenous contrast and with a 3mm reconstruction was also acquired and the CT scan performed at the Radiology Department was canceled. As a result, 28 patients benefited from performing both studies at the same time. PET imaging was evaluated by an experienced nuclear medicine physician by visual assessment (SUVmax-18F-FDG uptake in the area of interest). 18F-FDG uptake was considered pathological if it was greater than background tissue or blood pool activity at primary tumor site or lymph node and did not correlate with physiological activity. For subcentimeter lymph nodes, other pathological features such us shape and central necrosis were taken into consideration.Radiotherapy treatment planningAll 18F-FDG PET/CT scans were performed under RT treatment conditions. The scans were performed in conjunction by radiotherapy and nuclear medicine technologists, using a thermoplastic mask for immobilization. 18F-FDG PET/CT images were imported to the Oncentra Planning System® (Oncentra Master Plan 4.1.2.10). Metabolic images were merged with the CT scan were delineation and RT treatment volumes were planned. Gross tumor volume (GTV) was contoured at 40% of SUVmax (standardized uptake value).ResultsPatients characteristicsA total of 100 patients from our Tumor Registry with untreated primary HNC were included in this study. This group comprised 90 men and 10 women with a mean age of 60 years (range: 36–80). Staging, primary tumor localization and histopathology are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Treatment intent was discussed at the Head and Neck Multidisciplinary Team (HN-MDT). Ten of the 100 patients did not receive RT treatment (advanced disease, operable tumor or patient's preference). In 90 cases, RT was administered (Conventional 3D RT: 86 patients; Intensity modulated RT: 4 patients) with a mean RT dose of 6703 cGy (range for palliative treatment: 1600–3700 cGy; range for radical treatment: 6600–7000 cGy). Concurrent systemic treatment (Cisplatine 100mg/m2 or 40mg/m2, n=23; Cetuximab 250mg/m2, n=45) was administered in 68 and induction chemotherapy (Docetaxel 75mg/m2+Cisplatine 75mg/m2+5-Fluorouracil 750mg/m2) in 33 patients respectively.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Staging modificationsEvery change is detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> which represents the proportion of patients whose staging based on CT information was modified by 18F-FDG PET/CT. The main diagonal of the three tables shows those individuals in whom both classifications were coincident. Patients above the diagonal are overstaged and under the main diagonal are understaged. Staging changes are as follow:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>a:18F-FDG PET/CT modified primary tumor extension (cT) revealed a modification in 28 cases: in 14 cases tumor staging increased and in 14 cases it decreased. In all categories reclassification by 18F-FDG PET/CT was higher than 10%. A point to highlight is the cTx stage in CT, which is defined as a primary tumor that cannot be evaluated. Two patients with an undetected tumor were finally staged as cT4 tumor, resulting both in IVA stage.</li><li class="elsevierStyleListItem" id="lsti0010">-<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>b: When analyzing nodal disease information (cN), we found that 18F-FDG PET/CT resulted in a stage migration in 47 patients. Sixteen were down-staged and 31 patients up-staged due to 18F-FDG PET/CT information. Reclassification by 18F-FDG PET/CT was also higher than 10% in all categories. Main changes are as follow: 19 node negative patients were found to present metabolically active disease and 2 patients with suspicious nodal disease in CT were not metabolically active. Eight were diagnosed with bilateral nodal disease (cN2c) but 18F-FDG PET/CT image showed unilateral disease only and 5 staged as N positive (N1, N2A or N2B) turned into N2C (<a class="elsevierStyleCrossRef" href="#fig0005">Image 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015">-<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>c: According to AJCC 7th staging, 18F-FDG PET/CT determined a change in cTNM in 27 of 100 cases: 19 cases were up-staged and 8 down-staged. Reclassification by 18F-FDG PET/CT into IVA category was 5.9% and 0% in IVC. All other category reclassification was above 10%.</li></ul><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Therapeutic management modificationsTreatment intention changed from radical to palliative in 6 patients due to distant metastases detected by 18F-FDG PET/CT: 4 patients suffered from bone metastases, 1 had bone and liver metastases and 1 lung involvement. 18F-FDG PET/CT detected synchronous tumors in 8 patients which implied a modification in the therapeutic strategy: radical treatment intent was maintained in 7 of these patients but one of them received palliative treatment. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> details clinical findings and therapeutic management.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Tumor metabolic image obtained by the use of 18F-FDG PET/CT was taken into consideration when delineating the gross tumor volume (T-GTV) in all patients. It also helped us to determine nodal-GTV (N-GTV) as well as to select the appropriate nodal levels included in the radiotherapy beam. As no biopsy was undertook in case of disparity between CT and 18F-FDG PET/CT results, individualized decision was taken. No lymph node without metabolic activity was excluded from nodal volume in case of malignant suspicious disease in CT. If bilateral disease was found, nodal volume was enlarged.DiscussionHead and neck cancer (HNC) represents about 4% of all cancers occurring in Europe. Etiologic factors such as tobacco and alcohol are common to other pathologies. In consequence, patients with HNC are in risk of developing second primary tumors of the head and neck area, esophagus or lung.18F-FDG PET/CT provides biological and anatomic tumor information that is more accurate than either PET or CT alone.<a class="elsevierStyleCrossRefs" href="#bib0180">6,10,17</a>18F-FDG PET/CT is a useful tool in HNC due to its well-recognized advantages for diagnosis, staging, evaluation of treatment response and restaging.<a class="elsevierStyleCrossRefs" href="#bib0155">1,11</a> However, the use of 18F-FDG PET/CT in RT treatment planning is more controversial. Tumor size accuracy and nodal metastases detection are essential in planning RT. Several investigators have already reported more accurate staging with metabolic information compared with the use of CT alone.<a class="elsevierStyleCrossRefs" href="#bib0215">13,15</a> Also, it is reported that inter-observer variability in target volume delineation is reduced by using 18F-FDG PET/CT<a class="elsevierStyleCrossRefs" href="#bib0240">18,19</a> and facilitates adaptive RT in HNC.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> This is paramount in HNC where complex anatomic structures are so close. Although there is no consensus on the role of 18F-FDG PET/CT delineation in HNC as compared to other pathologies such as in lung cancer, current data supports changing treatment volumes and dose prescription based on 18F-FDG-PET/CT information.<a class="elsevierStyleCrossRefs" href="#bib0200">10,18,19</a>Our study analyzes how 18F-FDG PET/CT affects HNC staging and studies changes in the therapeutic approach compared to CT image alone. All 18F-FDG PET/CT scans were performed in the RT planning position.When studying tumor extension (cT), 18F-FDG PET/CT provides metabolic information that, correlated with anatomy, offers additional differentiation of tumor from healthy tissue. In this sense, better defining tumoral extent could affect the therapeutic index and could also affect quality of life by reducing acute and chronic toxicity. High sensitivity (93–100%) and specificity (94–98%) of 18F-FDG PET/CT for primary lesions 18F-FDG PET/CT has been reported<a class="elsevierStyleCrossRefs" href="#bib0250">20,21</a> as well as its role in a more accurate GTV definition.<a class="elsevierStyleCrossRefs" href="#bib0165">3,19</a>In the literature, smaller GTV is mainly reported when contouring with 18F-FDG PET/CT. In 2009, a change determined by 18F-FDG PET/CT in tumor stage was observed in 6 of 38 HNC patients (15.75%) by Guido et al.<a class="elsevierStyleCrossRef" href="#bib0260">22</a> The primary tumor GTV based on 18F-FDG PET/CT (PET-GTV) was smaller in 35 patients (92%) compared to the CT image (CT-GTV), although this difference was not statistically significant. Kajitani et al. did not found changes between PET-GTV and CT-GTV in 43 of 53 cases when they compared the location of the primary tumor. However, the CT-GTV sensitivity was lower than PET-GTV (81% versus 96%, p<0.01).<a class="elsevierStyleCrossRef" href="#bib0255">21</a> Delouya also compared primary tumor PET-GTV with CT-GTV, finding that PET-GTV was smaller (p<0.001).<a class="elsevierStyleCrossRef" href="#bib0165">3</a> Most recently, Leclerc et al. have demonstrated the use of 18F-FDG PET/CT in obtaining smaller treatment volumes rather than with CT in their study of 41 patients (p<0.0001).<a class="elsevierStyleCrossRef" href="#bib0265">23</a>In our study group, we observed a big percentage of patients reclassified due to 18F-FDG PET/CT. Tumor staging was modified in 27 patients (19% up-staged; 8% down-staged). Tumor-GTV delineation was based on 18F-FDG PET/CT images. In our experience, it allows easier delineation, especially in tumors difficult to visualize on CT alone, tumors with submucosal affectation or in patients with dental devices.In relation to nodal disease (cN), 18F-FDG PET/CT has low sensitivity in lymph nodes smaller than 1cm diameter which can result in false-negative cases<a class="elsevierStyleCrossRef" href="#bib0190">8</a> or may over-stage patients, identifying benign inflammatory disease as malignant. In spite of this critical point, the superiority of 18F-FDG PET/CT against anatomical techniques has been described in large studies.<a class="elsevierStyleCrossRefs" href="#bib0185">7,8,17</a> Shu-Hang Ng and colleges studied 135 patients with no nodal disease on physical examination and performed three different imaging tests (18F-FDG PET/CT, MRI and CT). Their results showed that 18F-FDG PET/CT was the most sensitive diagnosis tool. In this line, Jin Taek Park also demonstrated superiority of 18F-FDG PET/CT in detecting contralateral neck metastases compared to CT or MRI scan.<a class="elsevierStyleCrossRef" href="#bib0270">24</a>Nodal tumor disease is one the most important prognostic factors in HNC.<a class="elsevierStyleCrossRefs" href="#bib0180">6,25</a> Therefore, accurate detection is essential in delineating RT treatment volumes. 18F-FDG PET/CT has been considered an important tool to determine which lymph nodes should be included in the treatment boost volume and which should be excluded.<a class="elsevierStyleCrossRef" href="#bib0280">26</a> Simple visual interpretation of the PET image is the most commonly applied technique but it is operator-dependent; other alternatives such as automatic delineation are being studied.<a class="elsevierStyleCrossRefs" href="#bib0170">4,27,28</a> A standardized method for signal segmentation may be established to avoid false-positive readings of the 18F-FDG PET/CT signal caused by peritumoral inflammation around the nodal disease.In our study, nodal disease staging has globally changed in 46 patients of the 100 included. Therefore, our treatment volumes were modified to include PET-diagnosis nodal disease and adapt radiotherapy dose. Also, cervical levels irradiated prophylactically were better selected according to 18F-FDG PET/CT information.Since 18F-FDG PET/CT is a whole-body technique, it has the ability of detecting more distant metastases than conventional studies such as CT or MRI. Kolarova described in 2012, 5.7% of new distant metastases in his study group of 53 patients<a class="elsevierStyleCrossRef" href="#bib0175">5</a> and Abramyuk reported a 13.7% cM stage modification, mainly due to the new disease diagnosis.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> In our study, new metastases were detected in 6 patients by using 18F-FDG PET/CT and treatment intention changed into palliative. In this line, a synchronous tumor was diagnosed in 8 patients, implying also a modification in the global disease approach. Only one of these had to receive palliative treatment.In summary, 18F-FDG PET/CT clearly affects our therapeutic strategy. Studies such as that by Koschy et al.<a class="elsevierStyleCrossRef" href="#bib0300">30</a> have reported 14% of clinical changes and 25% of RT intention changes. Abramyuk and colleges described 27% and 14%, respectively.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> In our group of 100 patients, global disagreement in cTNM staging between CT and 18F-FDG PET/CT was found in 27% of patients and 18F-FDG PET/CT determined a palliative treatment in 7% (6 new metastases diagnosed and 1 synchronous tumor).Although 18F-FDG PET/CT is not part of the routine staging for HNC in many centers, we believe it is useful. Our investigation, which includes one of the largest study samples, suggests that 18F-FDG PET/CT information is more accurate than CT study alone in pre-RT staging of HNC. In our institution the use of 18F-FDG PET/CT in HNC started in 2009 and due to its preliminary benefits, the HN-MDT included it in the protocol for staging and RT planning for all advanced tumors and high risk early disease.Our study, however, must be interpreted with caution. It analyzes information retrospectively, which always limits the access to data, includes a variety of head and neck cancer subtypes and we are yet to determine whether it affects survival and/or long-term toxicity. Pathological uptake by 18F-FDG PET/CT at lymph nodes was not histologically confirmed and RT planning was performed at 40% of SUVmax. It is one of the most accepted values for planning, but other methods not yet approved could be superior.Modern RT techniques require precise disease identification and delineation of treatment volumes. 18F-FDG PET/CT improves staging in HNC and therefore helps physicians to select the best treatment according to patient's characteristics. Although planning with 18F-FDG PET/CT in HNC is still being investigated, the most recent studies suggest a greater accuracy in delineating tumor-GTV and nodal-GTV. The modification of both implies adapting the radiotherapy prescribed dose which can be related with a change in the disease outcome and toxicity in HNC. Reference guidelines such as NCCN, IAEA or the Spanish Society of Radiation Oncology consider 18F-FDG PET/CT potentially appropriate and recommend it for RT planning. We believe that the implementation of this tool in locally advanced HNC has advantages, but further studies are required to establish stronger conclusions about clinical outcomes such as disease free-survival, relapse rate, toxicity and mortality.Conflicts of interestAll authors have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1185592" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods and materials" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1105398" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1185593" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1105399" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods and materials" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "CT and F-FDG PET/CT image acquisition and interpretation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Radiotherapy treatment planning" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Patients characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Staging modifications" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Therapeutic management modifications" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-26" "fechaAceptado" => "2018-08-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1105398" "palabras" => array:4 [ 0 => "18F-FDG PET/CT" 1 => "Head and neck cancer" 2 => "Staging" 3 => "Radiotherapy planning" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1105399" "palabras" => array:4 [ 0 => "18F-FDG PET/TC" 1 => "Cáncer cabeza y cuello" 2 => "Estadificación" 3 => "Planificación radioterapia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "PurposeThe aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. Methods and materialsOne hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients’ staging reclassification. Changes in therapeutic strategy were analyzed. Results18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+(N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. Conclusions18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods and materials" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosInvestigar el uso de la 18F-FDG(flúor-18 fluorodesoxiglucosa) PET/TC en la estadificación del cáncer de cabeza y cuello (CCC) y su repercusión en la decisión terapéutica y planificación de tratamiento radioterápico. Material y métodosSe incluyen 100 pacientes con CCC y la siguiente localización tumoral: 18% cavidad oral, 20% orofaringe, 12% hipofaringe, 11% nasofaringe, 37% laringe, 2% senos paranasales. La estadificación tumoral según la AJCC (American Joint Committee of Cancer, 7th) es: 5%-I, 7%-II, 14%-III, 61%-IVA, 7%-IVB, 6%-IVC. Se les realiza una TC y una 18F-FDG PET/TC en condiciones de simulación para comparar la reclasificación del estadiaje. Además, se analizan los cambios de actitud terapéutica. ResultadosLa 18F-FDG PET/CT detecta 6 pacientes metastásicos que requieren tratamiento paliativo y 8 tumores sincrónicos, siendo uno paliativo. Se produce una reclasificación del estadiaje en 27 pacientes. La extensión tumoral varía en 28 (14% sobre-estadificación, 14% infra-estadificación), implicando una variación en el contorneo del GTV (Gross Tumor Volume). La estadificación ganglionar cambia en 47: 8 pacientes son infra-estadificados (N2C cambia a N2A/N2B/N1) y 2 son falsos positivos. Diecinueve pacientes son falsos negativos y 5 con afectación ganglionar unilateral (N1/N2A/N2B) muestran actividad metabólica bilateral. Estos cambios de estadificación implican una adaptación del volumen ganglionar a irradiar. ConclusionesLa 18F-FDG PET/TC produce una reclasificación superior al 10% en casi todas las categorías estudiadas (cTNM, extensión tumoral, enfermedad ganglionar) y detecta más estadíos metastásicos y tumores sincrónicos que los estudios convencionales, lo que genera un impacto en el manejo del paciente y contorneo de los volúmenes de radioterapia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pedraza S, Ruiz-Alonso A, Hernández-Martínez AC, Cabello E, Lora D, Pérez-Regadera JF. 18F-FDG PET/TC para la estadificación y delineación del volumen de radioterapia en el cáncer de cabeza y cuello. Rev Esp Med Nucl Imagen Mol. 2019;38:154–159." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Image 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1489 "Ancho" => 2500 "Tamanyo" => 114681 ] ] "descripcion" => array:1 [ "en" => "CT scan (A) from a patient with a cT3N0 hypofarynx carcinoma. PET-CT show subcentimeter lymph nodes in left retropharynx level (SUVmax=13.99) and left IIA level (SUVmax=11.19). Final stage: cT3N2bM0, IVA." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients (n=100) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Stage</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Tumor localization</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oral cavity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oropharynx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypopharynx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasopharynx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Larynx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Para-nasal sinuses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Histopathology</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Squamous cell carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphoepithelioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adenoid cystic carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Undifferentiated carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021867.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient clinical characteristics." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">(A) cT changes</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">18F-FDG-PET/CT</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Reclassified=28 \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tx \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">CT</td><td class="td" title="table-entry " align="left" valign="top">T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (36%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (45.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (12.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021871.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">(B) cN changes</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">18F-FDG-PET/CT</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Reclassified=47 \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N2A \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N2B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N2C \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">CT</td><td class="td" title="table-entry " align="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (54.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (60%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N2A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N2B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (33%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N2C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (53.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021868.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">(C) cTNM changes</th><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">18F-FDG-PET/CT</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Reclassified=27 \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">II \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">III \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IVA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IVB \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IVC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="7" align="left" valign="top">CT</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (10%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (60%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (5.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021870.png" ] ] ] ] "descripcion" => array:1 [ "en" => "18F-FDG-PET/CT vs CT: staging reclassification in TNM staging (A), tumor extension-cT (B) and nodal disease affectation-cN (C) comparing 18F-FDG-PET/CT and CT (Tx: primary tumor cannot be assessed)." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Synchronous tumors/staging [AJCC] \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Therapeutic management \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous larynx carcinoma (cT2N0M0, II) Squamous oropharynx carcinoma (cT2N0M0, II) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemoradiotherapy in both locations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous larynx carcinoma (cT3N0M0, III) Non-small cell lung cancer (cT1N0M0, IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemoradiotherapy in HNC+Lung surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous larynx carcinoma (cT4N3M0, IVB) Non-small cell lung cancer (cT2N1M0, IIA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palliative chemotherapy in both locations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous larynx carcinoma (cT2N2M0, IVA) Esophagus carcinoma (cT4N0M0, IIIA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemoradiotherapy in both locations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous hypopharynx carcinoma (cT3N2M0, IVA) Esophagus carcinoma (cT1N0M0, IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemoradiotherapy in both locations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous oropharynx carcinoma (cT4aN0M0, IVA) Low risk prostate cancer of NCCN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemoradiotherapy in HNC+prostate follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous hypopharynx carcinoma (cT2N0M0, II) In situ carcinoma of colon (cTisN0M0, 0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemoradiotherapy in HNC+colon surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous larynx carcinoma (cT1N0M0, I) Hepatocarcinoma grade A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Radical radiotherapy in HNC+Liver radiofrequency \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2021869.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Synchronous tumors detected by 18F-FDG-PET/CT and therapeutic management." ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 23761 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Head and Neck Cancer (version 2.2018)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "National Comprehensive Cancer Network" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2018" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT)]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Hodapp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Strahlenther Onkol Organ Dtsch Rontgengesellschaft Al" "fecha" => "2012" "volumen" => "188" "paginaInicial" => "97" "paginaFinal" => "99" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F-FDG-PET imaging in radiotherapy tumor volume delineation in treatment of head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Delouya" 1 => "L. Igidbashian" 2 => "A. Houle" 3 => "M. Bélair" 4 => "L. Boucher" 5 => "C. Cohade" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol" "fecha" => "2011" "volumen" => "101" "paginaInicial" => "362" "paginaFinal" => "368" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional imaging in radiation therapy planning for head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.A. Pérez Romasanta" 1 => "M.J. García Velloso" 2 => "A. López Medina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rep Pract Oncol Radiother" "fecha" => "2013" "volumen" => "18" "paginaInicial" => "376" "paginaFinal" => "382" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PET/CT significance for planning radiotherapy of head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Kolarova" 1 => "J. Vanasek" 2 => "V. Kandrnal" 3 => "K. Odrazka" 4 => "L. Dusek" 5 => "V. Chrobok" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neoplasma" "fecha" => "2012" "volumen" => "59" "paginaInicial" => "536" "paginaFinal" => "540" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.-H. Ng" 1 => "T.-C. Yen" 2 => "J.T.-C. Chang" 3 => "S.-C. Chan" 4 => "S.-F. Ko" 5 => "H.-M. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol Off J Am Soc Clin Oncol" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "4371" "paginaFinal" => "4376" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0185" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F fluorodeoxyglucose PET/CT in head and neck squamous cell carcinoma with negative neck palpation findings: a prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.-L. Roh" 1 => "J.P. Park" 2 => "J.S. Kim" 3 => "J.H. Lee" 4 => "K.-J. Cho" 5 => "S.-H. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiology" "fecha" => "2014" "volumen" => "271" "paginaInicial" => "153" "paginaFinal" => "161" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0190" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined [18F]fluorodeoxyglucose positron emission tomography and computed tomography for detecting contralateral neck metastases in patients with head and neck squamous cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.Y. Kim" 1 => "J.S. Kim" 2 => "H. Doo" 3 => "H. Lee" 4 => "J.H. Lee" 5 => "K.-J. Cho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Oral Oncol" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "376" "paginaFinal" => "380" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0195" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18FDG-PET/CT for detecting distant metastases and second primary cancers in patients with head and neck cancer. A meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.-Z. Xu" 1 => "D.-J. Guan" 2 => "Z.-Y. He" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Oral Oncol" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "560" "paginaFinal" => "565" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0200" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "<a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="http://www-pub.iaea.org/books/IAEABooks/8367/Appropriate-Use-of-FDG-PET-for-the-Management-of-Cancer-Patients">http://www-pub.iaea.org/books/IAEABooks/8367/Appropriate-Use-of-FDG-PET-for-the-Management-of-Cancer-Patients</a>" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Appropriate use of FDG-PET for the management of cancer patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "IAEA" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2010" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0205" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based guideline recommendations on the use of positron emission tomography imaging in head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Yoo" 1 => "S. Henderson" 2 => "C. Walker-Dilks" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Oncol R Coll Radiol G B" "fecha" => "2013" "volumen" => "25" "paginaInicial" => "e33" "paginaFinal" => "e66" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0210" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations of the Spanish Societies of Radiation Oncology (SEOR), Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on 18F-FDG PET-CT for radiotherapy treatment planning" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Cooperative Group for PET-CT in Radiotherapy Treatment Planning" 1 => "B. Caballero Perea" 2 => "A.C. Villegas" 3 => "J.M.D. Rodríguez" 4 => "M.J.G. Velloso" 5 => "A.M.G. Vicente" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rep Pract Oncol Radiother J Gt Cancer Cent Poznan Pol Soc Radiat Oncol" "fecha" => "2012" "volumen" => "17" "paginaInicial" => "298" "paginaFinal" => "318" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0215" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positron emission tomography with [18F]fluorodeoxyglucose improves staging and patient management in patients with head and neck squamous cell carcinoma: a multicenter prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Lonneux" 1 => "M. Hamoir" 2 => "H. Reychler" 3 => "P. Maingon" 4 => "C. Duvillard" 5 => "G. Calais" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol Off J Am Soc Clin Oncol" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "1190" "paginaFinal" => "1195" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0220" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AJCC cancer staging atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.C. Compton" 1 => "D.R. Byrd" 2 => "J. Garcia-Aguilar" 3 => "S.H. Kurtzman" 4 => "A. Olawaiye" 5 => "M.K. Washington" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2a ed." "fecha" => "2012" "editorial" => "Springer-Verlag" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0225" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessing the value of risk predictions by using risk stratification tables" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Janes" 1 => "M.S. Pepe" 2 => "W. Gu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2008" "volumen" => "149" "paginaInicial" => "751" "paginaFinal" => "760" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0230" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.M. Ridker" 1 => "J.E. Buring" 2 => "N. Rifai" 3 => "N.R. Cook" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "2007" "volumen" => "297" "paginaInicial" => "611" "paginaFinal" => "619" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0235" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of 18F-FDG PET/CT and CT/MRI with histopathologic correlation in patients undergoing salvage surgery for head and neck squamous cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.Y. Kim" 1 => "J.S. Kim" 2 => "J.S. Yi" 3 => "J.H. Lee" 4 => "S.-H. Choi" 5 => "S.Y. Nam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2011" "volumen" => "18" "paginaInicial" => "2579" "paginaFinal" => "2584" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0240" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "MUFACE. Guía PET-TAC. Protocolo de prescripción. Mutualidad General de Funcionarios Civiles del Estado; 2011." ] ] ] 18 => array:3 [ "identificador" => "bib0245" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary tumor delineation based on 18FDG PET for locally advanced head and neck cancer treated by chemo-radiotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Leclerc" 1 => "E. Lartigau" 2 => "T. Lacornerie" 3 => "J.-F. Daisne" 4 => "A. Kramar" 5 => "V. Grégoire" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol" "fecha" => "2015" "volumen" => "116" "paginaInicial" => "87" "paginaFinal" => "93" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0250" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical evidence on PET-CT for radiation therapy planning in head and neck tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.G.C. Troost" 1 => "D.A.X. Schinagl" 2 => "J. Bussink" 3 => "W.J.G. Oyen" 4 => "J.H.A.M. Kaanders" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol" "fecha" => "2010" "volumen" => "96" "paginaInicial" => "328" "paginaFinal" => "334" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0255" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of FDG-PET for defining gross tumor volume of head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Kajitani" 1 => "I. Asakawa" 2 => "F. Uto" 3 => "E. Katayama" 4 => "K. Inoue" 5 => "T. Tamamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Radiat Res (Tokyo)" "fecha" => "2013" "volumen" => "54" "paginaInicial" => "671" "paginaFinal" => "678" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0260" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined 18F-FDG-PET/CT imaging in radiotherapy target delineation for head-and-neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Guido" 1 => "L. Fuccio" 2 => "B. Rombi" 3 => "P. Castellucci" 4 => "A. Cecconi" 5 => "F. Bunkheila" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Radiat Oncol Biol Phys" "fecha" => "2009" "volumen" => "73" "paginaInicial" => "759" "paginaFinal" => "763" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0265" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "FDG-PET staging and importance of lymph node SUV in head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Kubicek" 1 => "C. Champ" 2 => "S. Fogh" 3 => "F. Wang" 4 => "E. Reddy" 5 => "C. Intenzo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Head Neck Oncol" "fecha" => "2010" "volumen" => "2" "paginaInicial" => "19" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0270" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F FDG PET/CT versus CT/MR imaging and the prognostic value of contralateral neck metastases in patients with head and neck squamous cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.T. Park" 1 => "J.-L. Roh" 2 => "J.S. Kim" 3 => "J.H. Lee" 4 => "K.-J. Cho" 5 => "S.-H. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiology" "fecha" => "2016" "volumen" => "279" "paginaInicial" => "481" "paginaFinal" => "491" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0275" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison between anatomical cross-sectional imaging and 18F-FDG PET/CT in the staging, restaging, treatment response, and long-term surveillance of squamous cell head and neck cancer: a systematic literature overview" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Evangelista" 1 => "A.R. Cervino" 2 => "S. Chondrogiannis" 3 => "M.C. Marzola" 4 => "A.M. Maffione" 5 => "P.M. Colletti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nucl Med Commun" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "123" "paginaFinal" => "134" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0280" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PET-CT for response assessment and treatment adaptation in head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Bussink" 1 => "C.M.L. van Herpen" 2 => "J.H.A.M. Kaanders" 3 => "W.J.G. Oyen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "661" "paginaFinal" => "669" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0285" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The potential advantages of 18FDG PET/CT-based target volume delineation in radiotherapy planning of head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.N. Moule" 1 => "I. Kayani" 2 => "S.A. Moinuddin" 3 => "K. Meer" 4 => "C. Lemon" 5 => "K. Goodchild" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol" "fecha" => "2010" "volumen" => "97" "paginaInicial" => "189" "paginaFinal" => "193" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0290" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor volume delineation in head and neck cancer with 18-fluor-fluorodeoxiglucose positron emission tomography: adaptive thresholding method applied to primary tumors and metastatic lymph nodes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.A. Perez-Romasanta" 1 => "M. Bellon-Guardia" 2 => "J. Torres-Donaire" 3 => "E. Lozano-Martin" 4 => "M. Sanz-Martin" 5 => "J. Velasco-Jimenez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Transl Oncol" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "283" "paginaFinal" => "293" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0295" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modification of staging and treatment of head and neck cancer by FDG-PET/CT prior to radiotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Abramyuk" 1 => "S. Appold" 2 => "K. Zöphel" 3 => "M. Baumann" 4 => "N. Abolmaali" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Strahlenther Onkol Organ Dtsch Rontgengesellschaft Al" "fecha" => "2013" "volumen" => "189" "paginaInicial" => "197" "paginaFinal" => "201" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0300" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "F-18 FDG PET-CT fusion in radiotherapy treatment planning for head and neck cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Koshy" 1 => "A.C. Paulino" 2 => "R. Howell" 3 => "D. Schuster" 4 => "R. Halkar" 5 => "L.W. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Head Neck" "fecha" => "2005" "volumen" => "27" "paginaInicial" => "494" "paginaFinal" => "502" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003800000003/v1_201905020850/S225380891830079X/v1_201905020850/en/main.assets" "Apartado" => array:4 [ "identificador" => "34047" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003800000003/v1_201905020850/S225380891830079X/v1_201905020850/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380891830079X?idApp=UINPBA00004N"]

Statistics

Original Article

18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer

18F-FDG PET/TC para la estadificación y delineación del volumen de radioterapia en el cáncer de cabeza y cuello

Sara Pedrazaa,

Corresponding author

s.pedraza87@gmail.com

Corresponding author.

, Ana Ruiz-Alonsoa, Ana Cristina Hernández-Martínezb, Eduardo Cabelloa, David Lorac, José Fermín Pérez-Regaderaa

a Department of Radiation Oncology, University Hospital 12 de Octubre, Madrid, Spain

b Department of Nuclear Medicine, University Hospital 12 de Octubre, Madrid, Spain

c Clinical Epidemiology Unit, CIBERESP, University Hospital 12 de Octubre, Madrid, Spain

Read

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:24 [
  "pii" => "S225380891830079X"
  "issn" => "22538089"
  "doi" => "10.1016/j.remnie.2018.08.003"
  "estado" => "S300"
  "fechaPublicacion" => "2019-05-01"
  "aid" => "1013"
  "copyright" => "Sociedad Espa&#241;ola de Medicina Nuclear e Imagen Molecular"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:154-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 7
    "formatos" => array:2 [
      "HTML" => 3
      "PDF" => 4
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S2253654X18300520"
      "issn" => "2253654X"
      "doi" => "10.1016/j.remn.2018.08.002"
      "estado" => "S300"
      "fechaPublicacion" => "2019-05-01"
      "aid" => "1013"
      "copyright" => "Sociedad Espa&#241;ola de Medicina Nuclear e Imagen Molecular"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:154-9"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 476
        "formatos" => array:2 [
          "HTML" => 428
          "PDF" => 48
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC para la estadificaci&#243;n y la delineaci&#243;n del volumen de radioterapia en el c&#225;ncer de cabeza y cuello"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "154"
            "paginaFinal" => "159"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in staging and delineation of radiotherapy volume for head and neck cancer"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1489
                "Ancho" => 2500
                "Tamanyo" => 114681
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio TC &#40;A&#41; de un paciente con un carcinoma de hipofaringe cT3N0&#46; La PET&#47;TC &#40;B&#41; muestra ganglios linf&#225;ticos subcentim&#233;tricos en el espacio retrofar&#237;ngeo izquierdo &#40;SUVm&#225;x<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44;99&#41; y el nivel IIA izquierdo &#40;SUVm&#225;x<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44;19&#41;&#46; Estadio final&#58; cT3N2bM0&#44; IVA&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "S&#46; Pedraza, A&#46; Ruiz-Alonso, A&#46;C&#46; Hern&#225;ndez-Mart&#237;nez, E&#46; Cabello, D&#46; Lora, J&#46;F&#46; P&#233;rez-Regadera"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Pedraza"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Ruiz-Alonso"
              ]
              2 => array:2 [
                "nombre" => "A&#46;C&#46;"
                "apellidos" => "Hern&#225;ndez-Mart&#237;nez"
              ]
              3 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Cabello"
              ]
              4 => array:2 [
                "nombre" => "D&#46;"
                "apellidos" => "Lora"
              ]
              5 => array:2 [
                "nombre" => "J&#46;F&#46;"
                "apellidos" => "P&#233;rez-Regadera"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S225380891830079X"
          "doi" => "10.1016/j.remnie.2018.08.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380891830079X?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18300520?idApp=UINPBA00004N"
      "url" => "/2253654X/0000003800000003/v2_202009160717/S2253654X18300520/v2_202009160717/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2253808919300138"
    "issn" => "22538089"
    "doi" => "10.1016/j.remnie.2019.01.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "1043"
    "copyright" => "Sociedad Espa&#241;ola de Medicina Nuclear e Imagen Molecular"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:160-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2
      "PDF" => 2
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Association between white matter lesions and cerebral glucose metabolism in patients with cognitive impairment"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "160"
          "paginaFinal" => "166"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Asociaci&#243;n entre da&#241;os en la sustancia blanca y metabolismo de la glucosa cerebral en pacientes con disfunci&#243;n cognitiva"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1109
              "Ancho" => 2022
              "Tamanyo" => 149170
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of the study population&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Hyun-Jung No, Hyon-Ah Yi, Kyoung Sook Won, Hyuk Won Chang, Hae Won Kim"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Hyun-Jung"
              "apellidos" => "No"
            ]
            1 => array:2 [
              "nombre" => "Hyon-Ah"
              "apellidos" => "Yi"
            ]
            2 => array:2 [
              "nombre" => "Kyoung Sook"
              "apellidos" => "Won"
            ]
            3 => array:2 [
              "nombre" => "Hyuk Won"
              "apellidos" => "Chang"
            ]
            4 => array:2 [
              "nombre" => "Hae Won"
              "apellidos" => "Kim"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S2253654X18302294"
        "doi" => "10.1016/j.remn.2018.12.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18302294?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300138?idApp=UINPBA00004N"
    "url" => "/22538089/0000003800000003/v1_201905020850/S2253808919300138/v1_201905020850/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2253808919300011"
    "issn" => "22538089"
    "doi" => "10.1016/j.remnie.2018.11.009"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "1044"
    "copyright" => "Sociedad Espa&#241;ola de Medicina Nuclear e Imagen Molecular"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:147-53"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3
      "formatos" => array:2 [
        "HTML" => 1
        "PDF" => 2
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Diagnostic impact of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT on the management of rare breast carcinomas&#58; apocrine and neuroendocrine carcinomas"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "147"
          "paginaFinal" => "153"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Impacto diagn&#243;stico de la <span class="elsevierStyleSup">18</span>F-FDG en el tratamiento de carcinomas de mama raros&#58; carcinomas apocrinos y neuroendocrinos"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 778
              "Ancho" => 2167
              "Tamanyo" => 144986
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">PET&#44; CT&#44; fusion &#40;F&#41; sections&#44; and maximum intensity projection &#40;MIP&#41; image of a 43-year-old female patient with Luminal B type apocrine cancer in the lower-outer quadrant of right breast&#46; Size of the primary tumor&#58; 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#44; SUVmax&#58; 10&#46;6 &#40;black and white arrows&#41;&#46; Short axis diameter of metastatic axillary lymph node&#58;0&#46;8<span class="elsevierStyleHsp" style=""></span>cm&#44; SUVmax&#58; 9&#46;2 &#40;dashed black and white arrows&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Esra Arslan, Tevfik Fikret &#199;ermik, Fadime Didem Can Trabulus, Esra Canan Kelten Talu, &#350;erife Ba&#351;aran"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Esra"
              "apellidos" => "Arslan"
            ]
            1 => array:2 [
              "nombre" => "Tevfik Fikret"
              "apellidos" => "&#199;ermik"
            ]
            2 => array:2 [
              "nombre" => "Fadime Didem"
              "apellidos" => "Can Trabulus"
            ]
            3 => array:2 [
              "nombre" => "Esra Canan"
              "apellidos" => "Kelten Talu"
            ]
            4 => array:2 [
              "nombre" => "&#350;erife"
              "apellidos" => "Ba&#351;aran"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S2253654X18301975"
        "doi" => "10.1016/j.remn.2018.11.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18301975?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300011?idApp=UINPBA00004N"
    "url" => "/22538089/0000003800000003/v1_201905020850/S2253808919300011/v1_201905020850/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in staging and delineation of radiotherapy volume for head and neck cancer"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "154"
        "paginaFinal" => "159"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Sara Pedraza, Ana Ruiz-Alonso, Ana Cristina Hern&#225;ndez-Mart&#237;nez, Eduardo Cabello, David Lora, Jos&#233; Ferm&#237;n P&#233;rez-Regadera"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Sara"
            "apellidos" => "Pedraza"
            "email" => array:1 [
              0 => "s&#46;pedraza87&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Ruiz-Alonso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ana Cristina"
            "apellidos" => "Hern&#225;ndez-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "Cabello"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "David"
            "apellidos" => "Lora"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Jos&#233; Ferm&#237;n"
            "apellidos" => "P&#233;rez-Regadera"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Department of Radiation Oncology&#44; University Hospital 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Nuclear Medicine&#44; University Hospital 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Clinical Epidemiology Unit&#44; CIBERESP&#44; University Hospital 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC para la estadificaci&#243;n y delineaci&#243;n del volumen de radioterapia en el c&#225;ncer de cabeza y cuello"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Image 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1489
            "Ancho" => 2500
            "Tamanyo" => 114681
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">CT scan &#40;A&#41; from a patient with a cT3N0 hypofarynx carcinoma&#46; PET-CT show subcentimeter lymph nodes in left retropharynx level &#40;SUVmax<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#46;99&#41; and left IIA level &#40;SUVmax<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;19&#41;&#46; Final stage&#58; cT3N2bM0&#44; IVA&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Head and neck cancer &#40;HNC&#41; refers to a heterogeneous group formed by paranasal sinuses&#44; oral cavity&#44; nasopharynx&#44; oropharynx&#44; hypopharynx and larynx tumors&#46; In these tumors&#44; radiotherapy &#40;RT&#41; has long played an important role providing its main advantage&#58; organ-preservation&#46; From the 1990s&#44; intensity-modulated radiation therapy &#40;IMRT&#41; has revolutionized RT treatment&#46; This technique&#44; which achieves better dose conformity to the treatment volume while sparing organs at risk&#44; has been shown to be useful in HNC treatment planning&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; this modern RT requires precise volume delineation&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Traditionally&#44; head and neck &#40;HN&#41; CT has been the gold standard image technique for staging and RT treatment planning&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> HN-MRI provides complementary information on soft tissue involvement and nodal disease&#44; particularly for the oral cavity&#44; salivary glands and nasopharynx&#44; but due to logistic problems when image co-registration is performed&#44; it is not widely used in RT planning&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> Visual evaluation of positron emission tomography &#40;PET&#41; with fluorine-18 fluorodeoxyglucose &#40;<span class="elsevierStyleSup">18</span>F-FDG&#41; is superior to CT in identifying the tumor extension and nodal disease<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;8</span></a> in patients with HNC&#46; In addition&#44; unsuspected distant disease and synchronous tumors can also be identified&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Several authors and guidelines&#44; including the International Atomic Energy Agency &#40;IAEA&#41; or the National Comprehensive Cancer Network &#40;NCCN&#41;&#44; have already investigated the role of <span class="elsevierStyleSup">18</span>F-FDG PET integrated with CT &#40;<span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#41; in staging and delineation of the primary head and neck tumor and lymph node metastases in HNC&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;10&#8211;13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study is to explore the potential impact of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in HNC through our clinical daily practice&#46; We investigated its effect on the initial staging and we analyzed if a variation in staging&#44; alters the therapeutic strategy and therefore RT treatment planning&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods and materials</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0020" class="elsevierStylePara elsevierViewall">In this cohort study&#44; consecutive patients with untreated primary HNC were enrolled between June 2009 and January 2014&#46; Initially&#44; all patients were staged according to the AJCC staging classification<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> by performing a physical examination&#44; fiber-endoscopy if needed&#44; HN-CT and chest radiography&#46; All patients underwent a whole-body <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT for staging and also for delineation RT volumes&#46; Staging based on <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT information was compared with the classical staging based on HN-CT to detect differences&#46; The impact on patient management was determined by comparing the therapeutic management before and after <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was performed&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Age variable is presented as mean and range&#46; Categorical variables are presented as absolute and relative frequencies&#46; Risk stratification tables<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;16</span></a> were used to evaluate the benefit of using <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT information versus HN-CT&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">No formal ethics committee approval was required for this analysis of a routine clinical service&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">CT and <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT image acquisition and interpretation</span><p id="par0035" class="elsevierStylePara elsevierViewall">HN-CT was performed at the Radiology Service by using a <span class="elsevierStyleItalic">Phillips&#174; Brilliance Ict</span> scan&#46; Neck CT images were obtained from the base of the skull to the carina&#44; under quiet breathing&#44; with a 3<span class="elsevierStyleHsp" style=""></span>mm reconstruction&#46; Intravenous contrast was injected unless reported allergy or contraindication&#46; An experienced radiologist interpreted the images&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT scan was done at the Department of Nuclear Medicine by using our standard procedure&#46; Patients were instructed to fast for at least 6<span class="elsevierStyleHsp" style=""></span>hours before 18F-FDG PET&#47;CT&#46; Blood glucose level before the injection of 18F-FDG &#40;5 MBq&#47;Kg&#59; 250-450 MBq&#41; was measured to confirm it was lower than 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Images were taken 60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>min after injection&#44; using a hybrid PET-CT SIEMENS&#174; Biograph True Point&#46; Acquisition time was 3<span class="elsevierStyleHsp" style=""></span>min&#47;bed or 4<span class="elsevierStyleHsp" style=""></span>min if patient body mass index &#8805;30&#46; Images were reconstructed with a slice thickness of 5<span class="elsevierStyleHsp" style=""></span>mm&#46; Immediately before CT was acquired&#44; intravenous contrast was administered if no contraindications were present&#46; CT data were used for attenuation correction and anatomic localization&#46; Since 2012 onwards&#44; a selective <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT of HN region with intravenous contrast and with a 3<span class="elsevierStyleHsp" style=""></span>mm reconstruction was also acquired and the CT scan performed at the Radiology Department was canceled&#46; As a result&#44; 28 patients benefited from performing both studies at the same time&#46; PET imaging was evaluated by an experienced nuclear medicine physician by visual assessment &#40;SUVmax-<span class="elsevierStyleSup">18</span>F-FDG uptake in the area of interest&#41;&#46; <span class="elsevierStyleSup">18</span>F-FDG uptake was considered pathological if it was greater than background tissue or blood pool activity at primary tumor site or lymph node and did not correlate with physiological activity&#46; For subcentimeter lymph nodes&#44; other pathological features such us shape and central necrosis were taken into consideration&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Radiotherapy treatment planning</span><p id="par0045" class="elsevierStylePara elsevierViewall">All <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT scans were performed under RT treatment conditions&#46; The scans were performed in conjunction by radiotherapy and nuclear medicine technologists&#44; using a thermoplastic mask for immobilization&#46; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT images were imported to the Oncentra Planning System&#174; &#40;Oncentra Master Plan 4&#46;1&#46;2&#46;10&#41;&#46; Metabolic images were merged with the CT scan were delineation and RT treatment volumes were planned&#46; Gross tumor volume &#40;GTV&#41; was contoured at 40&#37; of SUVmax &#40;standardized uptake value&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patients characteristics</span><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 100 patients from our Tumor Registry with untreated primary HNC were included in this study&#46; This group comprised 90 men and 10 women with a mean age of 60 years &#40;range&#58; 36&#8211;80&#41;&#46; Staging&#44; primary tumor localization and histopathology are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Treatment intent was discussed at the Head and Neck Multidisciplinary Team &#40;HN-MDT&#41;&#46; Ten of the 100 patients did not receive RT treatment &#40;advanced disease&#44; operable tumor or patient&#39;s preference&#41;&#46; In 90 cases&#44; RT was administered &#40;Conventional 3D RT&#58; 86 patients&#59; Intensity modulated RT&#58; 4 patients&#41; with a mean RT dose of 6703 cGy &#40;range for palliative treatment&#58; 1600&#8211;3700 cGy&#59; range for radical treatment&#58; 6600&#8211;7000 cGy&#41;&#46; Concurrent systemic treatment &#40;Cisplatine 100<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> or 40<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#59; Cetuximab 250<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&#41; was administered in 68 and induction chemotherapy &#40;Docetaxel 75<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Cisplatine 75<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>5-Fluorouracil 750<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#41; in 33 patients respectively&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Staging modifications</span><p id="par0055" class="elsevierStylePara elsevierViewall">Every change is detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> which represents the proportion of patients whose staging based on CT information was modified by <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#46; The main diagonal of the three tables shows those individuals in whom both classifications were coincident&#46; Patients above the diagonal are overstaged and under the main diagonal are understaged&#46; Staging changes are as follow&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010"><span class="elsevierStyleItalic">Table 2</span></a><span class="elsevierStyleItalic">a&#58;</span><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT modified primary tumor extension &#40;cT&#41; revealed a modification in 28 cases&#58; in 14 cases tumor staging increased and in 14 cases it decreased&#46; In all categories reclassification by <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was higher than 10&#37;&#46; A point to highlight is the cTx stage in CT&#44; which is defined as a primary tumor that cannot be evaluated&#46; Two patients with an undetected tumor were finally staged as cT4 tumor&#44; resulting both in IVA stage&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010"><span class="elsevierStyleItalic">Table 2</span></a><span class="elsevierStyleItalic">b&#58;</span> When analyzing nodal disease information &#40;cN&#41;&#44; we found that <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT resulted in a stage migration in 47 patients&#46; Sixteen were down-staged and 31 patients up-staged due to <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT information&#46; Reclassification by <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was also higher than 10&#37; in all categories&#46; Main changes are as follow&#58; 19 node negative patients were found to present metabolically active disease and 2 patients with suspicious nodal disease in CT were not metabolically active&#46; Eight were diagnosed with bilateral nodal disease &#40;cN2c&#41; but <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT image showed unilateral disease only and 5 staged as N positive &#40;N1&#44; N2A or N2B&#41; turned into N2C &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Image 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010"><span class="elsevierStyleItalic">Table 2</span></a><span class="elsevierStyleItalic">c&#58;</span> According to AJCC 7th staging&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT determined a change in cTNM in 27 of 100 cases&#58; 19 cases were up-staged and 8 down-staged&#46; Reclassification by <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT into IVA category was 5&#46;9&#37; and 0&#37; in IVC&#46; All other category reclassification was above 10&#37;&#46;</p></li></ul></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Therapeutic management modifications</span><p id="par0075" class="elsevierStylePara elsevierViewall">Treatment intention changed from radical to palliative in 6 patients due to distant metastases detected by <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#58; 4 patients suffered from bone metastases&#44; 1 had bone and liver metastases and 1 lung involvement&#46; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT detected synchronous tumors in 8 patients which implied a modification in the therapeutic strategy&#58; radical treatment intent was maintained in 7 of these patients but one of them received palliative treatment&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> details clinical findings and therapeutic management&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Tumor metabolic image obtained by the use of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was taken into consideration when delineating the gross tumor volume &#40;T-GTV&#41; in all patients&#46; It also helped us to determine nodal-GTV &#40;N-GTV&#41; as well as to select the appropriate nodal levels included in the radiotherapy beam&#46; As no biopsy was undertook in case of disparity between CT and <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT results&#44; individualized decision was taken&#46; No lymph node without metabolic activity was excluded from nodal volume in case of malignant suspicious disease in CT&#46; If bilateral disease was found&#44; nodal volume was enlarged&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Head and neck cancer &#40;HNC&#41; represents about 4&#37; of all cancers occurring in Europe&#46; Etiologic factors such as tobacco and alcohol are common to other pathologies&#46; In consequence&#44; patients with HNC are in risk of developing second primary tumors of the head and neck area&#44; esophagus or lung&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT provides biological and anatomic tumor information that is more accurate than either PET or CT alone&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10&#44;17</span></a><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT is a useful tool in HNC due to its well-recognized advantages for diagnosis&#44; staging&#44; evaluation of treatment response and restaging&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;11</span></a> However&#44; the use of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in RT treatment planning is more controversial&#46; Tumor size accuracy and nodal metastases detection are essential in planning RT&#46; Several investigators have already reported more accurate staging with metabolic information compared with the use of CT alone&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;15</span></a> Also&#44; it is reported that inter-observer variability in target volume delineation is reduced by using <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> and facilitates adaptive RT in HNC&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> This is paramount in HNC where complex anatomic structures are so close&#46; Although there is no consensus on the role of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT delineation in HNC as compared to other pathologies such as in lung cancer&#44; current data supports changing treatment volumes and dose prescription based on <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT information&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;18&#44;19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Our study analyzes how <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT affects HNC staging and studies changes in the therapeutic approach compared to CT image alone&#46; All <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT scans were performed in the RT planning position&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When studying tumor extension &#40;cT&#41;&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT provides metabolic information that&#44; correlated with anatomy&#44; offers additional differentiation of tumor from healthy tissue&#46; In this sense&#44; better defining tumoral extent could affect the therapeutic index and could also affect quality of life by reducing acute and chronic toxicity&#46; High sensitivity &#40;93&#8211;100&#37;&#41; and specificity &#40;94&#8211;98&#37;&#41; of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT for primary lesions <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT has been reported<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;21</span></a> as well as its role in a more accurate GTV definition&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;19</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In the literature&#44; smaller GTV is mainly reported when contouring with <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#46; In 2009&#44; a change determined by <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in tumor stage was observed in 6 of 38 HNC patients &#40;15&#46;75&#37;&#41; by Guido et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> The primary tumor GTV based on <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT &#40;PET-GTV&#41; was smaller in 35 patients &#40;92&#37;&#41; compared to the CT image &#40;CT-GTV&#41;&#44; although this difference was not statistically significant&#46; Kajitani et al&#46; did not found changes between PET-GTV and CT-GTV in 43 of 53 cases when they compared the location of the primary tumor&#46; However&#44; the CT-GTV sensitivity was lower than PET-GTV &#40;81&#37; versus 96&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Delouya also compared primary tumor PET-GTV with CT-GTV&#44; finding that PET-GTV was smaller &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Most recently&#44; Leclerc et al&#46; have demonstrated the use of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in obtaining smaller treatment volumes rather than with CT in their study of 41 patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In our study group&#44; we observed a big percentage of patients reclassified due to <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#46; Tumor staging was modified in 27 patients &#40;19&#37; up-staged&#59; 8&#37; down-staged&#41;&#46; Tumor-GTV delineation was based on <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT images&#46; In our experience&#44; it allows easier delineation&#44; especially in tumors difficult to visualize on CT alone&#44; tumors with submucosal affectation or in patients with dental devices&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In relation to nodal disease &#40;cN&#41;&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT has low sensitivity in lymph nodes smaller than 1<span class="elsevierStyleHsp" style=""></span>cm diameter which can result in false-negative cases<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> or may over-stage patients&#44; identifying benign inflammatory disease as malignant&#46; In spite of this critical point&#44; the superiority of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT against anatomical techniques has been described in large studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;17</span></a> Shu-Hang Ng and colleges studied 135 patients with no nodal disease on physical examination and performed three different imaging tests &#40;<span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#44; MRI and CT&#41;&#46; Their results showed that <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was the most sensitive diagnosis tool&#46; In this line&#44; Jin Taek Park also demonstrated superiority of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in detecting contralateral neck metastases compared to CT or MRI scan&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Nodal tumor disease is one the most important prognostic factors in HNC&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;25</span></a> Therefore&#44; accurate detection is essential in delineating RT treatment volumes&#46; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT has been considered an important tool to determine which lymph nodes should be included in the treatment boost volume and which should be excluded&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Simple visual interpretation of the PET image is the most commonly applied technique but it is operator-dependent&#59; other alternatives such as automatic delineation are being studied&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;27&#44;28</span></a> A standardized method for signal segmentation may be established to avoid false-positive readings of the <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT signal caused by peritumoral inflammation around the nodal disease&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In our study&#44; nodal disease staging has globally changed in 46 patients of the 100 included&#46; Therefore&#44; our treatment volumes were modified to include PET-diagnosis nodal disease and adapt radiotherapy dose&#46; Also&#44; cervical levels irradiated prophylactically were better selected according to <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT information&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Since <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT is a whole-body technique&#44; it has the ability of detecting more distant metastases than conventional studies such as CT or MRI&#46; Kolarova described in 2012&#44; 5&#46;7&#37; of new distant metastases in his study group of 53 patients<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> and Abramyuk reported a 13&#46;7&#37; cM stage modification&#44; mainly due to the new disease diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> In our study&#44; new metastases were detected in 6 patients by using <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT and treatment intention changed into palliative&#46; In this line&#44; a synchronous tumor was diagnosed in 8 patients&#44; implying also a modification in the global disease approach&#46; Only one of these had to receive palliative treatment&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In summary&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT clearly affects our therapeutic strategy&#46; Studies such as that by Koschy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> have reported 14&#37; of clinical changes and 25&#37; of RT intention changes&#46; Abramyuk and colleges described 27&#37; and 14&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> In our group of 100 patients&#44; global disagreement in cTNM staging between CT and <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was found in 27&#37; of patients and <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT determined a palliative treatment in 7&#37; &#40;6 new metastases diagnosed and 1 synchronous tumor&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT is not part of the routine staging for HNC in many centers&#44; we believe it is useful&#46; Our investigation&#44; which includes one of the largest study samples&#44; suggests that <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT information is more accurate than CT study alone in pre-RT staging of HNC&#46; In our institution the use of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in HNC started in 2009 and due to its preliminary benefits&#44; the HN-MDT included it in the protocol for staging and RT planning for all advanced tumors and high risk early disease&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Our study&#44; however&#44; must be interpreted with caution&#46; It analyzes information retrospectively&#44; which always limits the access to data&#44; includes a variety of head and neck cancer subtypes and we are yet to determine whether it affects survival and&#47;or long-term toxicity&#46; Pathological uptake by <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT at lymph nodes was not histologically confirmed and RT planning was performed at 40&#37; of SUVmax&#46; It is one of the most accepted values for planning&#44; but other methods not yet approved could be superior&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Modern RT techniques require precise disease identification and delineation of treatment volumes&#46; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT improves staging in HNC and therefore helps physicians to select the best treatment according to patient&#39;s characteristics&#46; Although planning with <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in HNC is still being investigated&#44; the most recent studies suggest a greater accuracy in delineating tumor-GTV and nodal-GTV&#46; The modification of both implies adapting the radiotherapy prescribed dose which can be related with a change in the disease outcome and toxicity in HNC&#46; Reference guidelines such as NCCN&#44; IAEA or the Spanish Society of Radiation Oncology consider <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT potentially appropriate and recommend it for RT planning&#46; We believe that the implementation of this tool in locally advanced HNC has advantages&#44; but further studies are required to establish stronger conclusions about clinical outcomes such as disease free-survival&#44; relapse rate&#44; toxicity and mortality&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">All authors have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1185592"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Purpose"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods and materials"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1105398"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1185593"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1105399"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods and materials"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "CT and F-FDG PET&#47;CT image acquisition and interpretation"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Radiotherapy treatment planning"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Patients characteristics"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Staging modifications"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Therapeutic management modifications"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-02-26"
    "fechaAceptado" => "2018-08-29"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1105398"
          "palabras" => array:4 [
            0 => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT"
            1 => "Head and neck cancer"
            2 => "Staging"
            3 => "Radiotherapy planning"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1105399"
          "palabras" => array:4 [
            0 => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC"
            1 => "C&#225;ncer cabeza y cuello"
            2 => "Estadificaci&#243;n"
            3 => "Planificaci&#243;n radioterapia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim is to investigate the use of <span class="elsevierStyleSup">18</span>F-FDG &#40;fluorine-18 fluorodeoxyglucose&#41; PET&#47;CT in head and neck cancer &#40;HNC&#41; staging and its effect on the therapeutic strategy and radiotherapy &#40;RT&#41; planning&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods and materials</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">One hundred patients with HNC were included&#46; Primary tumor sites&#58; 18&#37; oral cavity&#44; 20&#37; oropharynx&#44; 12&#37; hypopharynx&#44; 11&#37; nasopharynx&#44; 37&#37; larynx&#44; 2&#37; paranasal sinuses&#46; Patients were staged according to the American Joint Committee of Cancer 7th edition&#46; Stage&#58; 5&#37; stage I&#44; 7&#37; stage II&#44; 14&#37; stage III&#44; 61&#37; stage IVA&#44; 7&#37; stage IVB and 6&#37; stage IVC&#46; A contrast-enhanced CT and a <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT acquired under RT position were performed&#46; Both exams were compared to analyze patients&#8217; staging reclassification&#46; Changes in therapeutic strategy were analyzed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT detected 6 distant metastases and treatment intention changed to palliative&#46; Eight synchronous tumors were detected&#59; one received palliative treatment&#46; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT reclassified cTNM staging in 27patients&#46; Tumor extension changed in 28 &#40;14&#37; up-staged&#59; 14&#37; down-staged&#41;&#44; implying a change in GTV &#40;Gross Tumor Volume&#41; delineation&#46; Nodal detection was reclassified in 47 patients&#58; 8 patients down-staged &#40;N2C to N2A&#47;N2B&#47;N1&#41; and 2 were false positive&#46; Nineteen patients were false negatives and 5 staged as N<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;N1&#47;N2A&#47;N2B&#41; turned out into N2C&#46; These staging modifications imply adapting the nodal volume to be irradiated&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT reclassification was higher than 10&#37; in almost all categories studied &#40;cTNM&#44; tumor extension and nodal disease&#41; and detects more metastases and synchronous tumors than conventional studies&#44; which has an impact on the therapeutic patient management and RT planning&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Purpose"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods and materials"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Investigar el uso de la <span class="elsevierStyleSup">18</span>F-FDG&#40;fl&#250;or-18 fluorodesoxiglucosa&#41; PET&#47;TC en la estadificaci&#243;n del c&#225;ncer de cabeza y cuello &#40;CCC&#41; y su repercusi&#243;n en la decisi&#243;n terap&#233;utica y planificaci&#243;n de tratamiento radioter&#225;pico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyen 100 pacientes con CCC y la siguiente localizaci&#243;n tumoral&#58; 18&#37; cavidad oral&#44; 20&#37; orofaringe&#44; 12&#37; hipofaringe&#44; 11&#37; nasofaringe&#44; 37&#37; laringe&#44; 2&#37; senos paranasales&#46; La estadificaci&#243;n tumoral seg&#250;n la AJCC &#40;<span class="elsevierStyleItalic">American Joint Committee of Cancer&#44; 7th</span>&#41; es&#58; 5&#37;-I&#44; 7&#37;-II&#44; 14&#37;-III&#44; 61&#37;-IVA&#44; 7&#37;-IVB&#44; 6&#37;-IVC&#46; Se les realiza una TC y una <span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC en condiciones de simulaci&#243;n para comparar la reclasificaci&#243;n del estadiaje&#46; Adem&#225;s&#44; se analizan los cambios de actitud terap&#233;utica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT detecta 6 pacientes metast&#225;sicos que requieren tratamiento paliativo y 8 tumores sincr&#243;nicos&#44; siendo uno paliativo&#46; Se produce una reclasificaci&#243;n del estadiaje en 27 pacientes&#46; La extensi&#243;n tumoral var&#237;a en 28 &#40;14&#37; sobre-estadificaci&#243;n&#44; 14&#37; infra-estadificaci&#243;n&#41;&#44; implicando una variaci&#243;n en el contorneo del GTV &#40;<span class="elsevierStyleItalic">Gross Tumor Volume</span>&#41;&#46; La estadificaci&#243;n ganglionar cambia en 47&#58; 8 pacientes son infra-estadificados &#40;N2C cambia a N2A&#47;N2B&#47;N1&#41; y 2 son falsos positivos&#46; Diecinueve pacientes son falsos negativos y 5 con afectaci&#243;n ganglionar unilateral &#40;N1&#47;N2A&#47;N2B&#41; muestran actividad metab&#243;lica bilateral&#46; Estos cambios de estadificaci&#243;n implican una adaptaci&#243;n del volumen ganglionar a irradiar&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La <span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC produce una reclasificaci&#243;n superior al 10&#37; en casi todas las categor&#237;as estudiadas &#40;cTNM&#44; extensi&#243;n tumoral&#44; enfermedad ganglionar&#41; y detecta m&#225;s estad&#237;os metast&#225;sicos y tumores sincr&#243;nicos que los estudios convencionales&#44; lo que genera un impacto en el manejo del paciente y contorneo de los vol&#250;menes de radioterapia&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pedraza S&#44; Ruiz-Alonso A&#44; Hern&#225;ndez-Mart&#237;nez AC&#44; Cabello E&#44; Lora D&#44; P&#233;rez-Regadera JF&#46; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC para la estadificaci&#243;n y delineaci&#243;n del volumen de radioterapia en el c&#225;ncer de cabeza y cuello&#46; Rev Esp Med Nucl Imagen Mol&#46; 2019&#59;38&#58;154&#8211;159&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0165" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Image 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1489
            "Ancho" => 2500
            "Tamanyo" => 114681
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">CT scan &#40;A&#41; from a patient with a cT3N0 hypofarynx carcinoma&#46; PET-CT show subcentimeter lymph nodes in left retropharynx level &#40;SUVmax<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#46;99&#41; and left IIA level &#40;SUVmax<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;19&#41;&#46; Final stage&#58; cT3N2bM0&#44; IVA&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Stage</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Tumor localization</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oral cavity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oropharynx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypopharynx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nasopharynx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Larynx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Para-nasal sinuses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Histopathology</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Squamous cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lymphoepithelioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adenoid cystic carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Undifferentiated carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2021867.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient clinical characteristics&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:3 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">&#40;A&#41; cT changes</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Reclassified<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">CT</td><td class="td" title="table-entry  " align="left" valign="top">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;45&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;12&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2021871.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">&#40;B&#41; cN changes</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Reclassified<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N2A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">CT</td><td class="td" title="table-entry  " align="left" valign="top">N0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;54&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N2A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N2B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N2C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;53&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2021868.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">&#40;C&#41; cTNM changes</th><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Reclassified<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="7" align="left" valign="top">CT</td><td class="td" title="table-entry  " align="left" valign="top">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2021870.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT vs CT&#58; staging reclassification in TNM staging &#40;A&#41;&#44; tumor extension-cT &#40;B&#41; and nodal disease affectation-cN &#40;C&#41; comparing <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT and CT &#40;Tx&#58; primary tumor cannot be assessed&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Synchronous tumors&#47;staging &#91;AJCC&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Therapeutic management&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous larynx carcinoma &#40;cT2N0M0&#44; II&#41;<br>Squamous oropharynx carcinoma &#40;cT2N0M0&#44; II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemoradiotherapy in both locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous larynx carcinoma &#40;cT3N0M0&#44; III&#41;<br>Non-small cell lung cancer &#40;cT1N0M0&#44; IA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemoradiotherapy in HNC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Lung surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous larynx carcinoma &#40;cT4N3M0&#44; IVB&#41;<br>Non-small cell lung cancer &#40;cT2N1M0&#44; IIA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Palliative chemotherapy in both locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous larynx carcinoma &#40;cT2N2M0&#44; IVA&#41;<br>Esophagus carcinoma &#40;cT4N0M0&#44; IIIA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemoradiotherapy in both locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous hypopharynx carcinoma &#40;cT3N2M0&#44; IVA&#41;<br>Esophagus carcinoma &#40;cT1N0M0&#44; IA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemoradiotherapy in both locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous oropharynx carcinoma &#40;cT4aN0M0&#44; IVA&#41;<br>Low risk prostate cancer of NCCN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemoradiotherapy in HNC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prostate follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous hypopharynx carcinoma &#40;cT2N0M0&#44; II&#41;<br>In situ carcinoma of colon &#40;cTisN0M0&#44; 0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemoradiotherapy in HNC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>colon surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous larynx carcinoma &#40;cT1N0M0&#44; I&#41;<br>Hepatocarcinoma grade A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radical radiotherapy in HNC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Liver radiofrequency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2021869.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Synchronous tumors detected by <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT and therapeutic management&#46;</p>"
        ]
      ]
      4 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.docx"
          "ficheroTamanyo" => 23761
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Head and Neck Cancer &#40;version 2&#46;2018&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "National Comprehensive Cancer Network"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;The ICRU Report 83&#58; prescribing&#44; recording and reporting photon-beam intensity-modulated radiation therapy &#40;IMRT&#41;&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46; Hodapp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Strahlenther Onkol Organ Dtsch Rontgengesellschaft Al"
                        "fecha" => "2012"
                        "volumen" => "188"
                        "paginaInicial" => "97"
                        "paginaFinal" => "99"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG-PET imaging in radiotherapy tumor volume delineation in treatment of head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Delouya"
                            1 => "L&#46; Igidbashian"
                            2 => "A&#46; Houle"
                            3 => "M&#46; B&#233;lair"
                            4 => "L&#46; Boucher"
                            5 => "C&#46; Cohade"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol"
                        "fecha" => "2011"
                        "volumen" => "101"
                        "paginaInicial" => "362"
                        "paginaFinal" => "368"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional imaging in radiation therapy planning for head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; P&#233;rez Romasanta"
                            1 => "M&#46;J&#46; Garc&#237;a Velloso"
                            2 => "A&#46; L&#243;pez Medina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rep Pract Oncol Radiother"
                        "fecha" => "2013"
                        "volumen" => "18"
                        "paginaInicial" => "376"
                        "paginaFinal" => "382"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PET&#47;CT significance for planning radiotherapy of head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Kolarova"
                            1 => "J&#46; Vanasek"
                            2 => "V&#46; Kandrnal"
                            3 => "K&#46; Odrazka"
                            4 => "L&#46; Dusek"
                            5 => "V&#46; Chrobok"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neoplasma"
                        "fecha" => "2012"
                        "volumen" => "59"
                        "paginaInicial" => "536"
                        "paginaFinal" => "540"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective study of &#91;18F&#93;fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;-H&#46; Ng"
                            1 => "T&#46;-C&#46; Yen"
                            2 => "J&#46;T&#46;-C&#46; Chang"
                            3 => "S&#46;-C&#46; Chan"
                            4 => "S&#46;-F&#46; Ko"
                            5 => "H&#46;-M&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Oncol Off J Am Soc Clin Oncol"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "4371"
                        "paginaFinal" => "4376"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleSup">18</span>F fluorodeoxyglucose PET&#47;CT in head and neck squamous cell carcinoma with negative neck palpation findings&#58; a prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;-L&#46; Roh"
                            1 => "J&#46;P&#46; Park"
                            2 => "J&#46;S&#46; Kim"
                            3 => "J&#46;H&#46; Lee"
                            4 => "K&#46;-J&#46; Cho"
                            5 => "S&#46;-H&#46; Choi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2014"
                        "volumen" => "271"
                        "paginaInicial" => "153"
                        "paginaFinal" => "161"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Combined &#91;18F&#93;fluorodeoxyglucose positron emission tomography and computed tomography for detecting contralateral neck metastases in patients with head and neck squamous cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Kim"
                            1 => "J&#46;S&#46; Kim"
                            2 => "H&#46; Doo"
                            3 => "H&#46; Lee"
                            4 => "J&#46;H&#46; Lee"
                            5 => "K&#46;-J&#46; Cho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Oral Oncol"
                        "fecha" => "2011"
                        "volumen" => "47"
                        "paginaInicial" => "376"
                        "paginaFinal" => "380"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleSup">18</span>FDG-PET&#47;CT for detecting distant metastases and second primary cancers in patients with head and neck cancer&#46; A meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;-Z&#46; Xu"
                            1 => "D&#46;-J&#46; Guan"
                            2 => "Z&#46;-Y&#46; He"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Oral Oncol"
                        "fecha" => "2011"
                        "volumen" => "47"
                        "paginaInicial" => "560"
                        "paginaFinal" => "565"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "<a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="http://www-pub.iaea.org/books/IAEABooks/8367/Appropriate-Use-of-FDG-PET-for-the-Management-of-Cancer-Patients">http&#58;&#47;&#47;www-pub&#46;iaea&#46;org&#47;books&#47;IAEABooks&#47;8367&#47;Appropriate-Use-of-FDG-PET-for-the-Management-of-Cancer-Patients</a>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Appropriate use of FDG-PET for the management of cancer patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "IAEA"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2010"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based guideline recommendations on the use of positron emission tomography imaging in head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Yoo"
                            1 => "S&#46; Henderson"
                            2 => "C&#46; Walker-Dilks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Oncol R Coll Radiol G B"
                        "fecha" => "2013"
                        "volumen" => "25"
                        "paginaInicial" => "e33"
                        "paginaFinal" => "e66"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations of the Spanish Societies of Radiation Oncology &#40;SEOR&#41;&#44; Nuclear Medicine &#38; Molecular Imaging &#40;SEMNiM&#41;&#44; and Medical Physics &#40;SEFM&#41; on <span class="elsevierStyleSup">18</span>F-FDG PET-CT for radiotherapy treatment planning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Cooperative Group for PET-CT in Radiotherapy Treatment Planning"
                            1 => "B&#46; Caballero Perea"
                            2 => "A&#46;C&#46; Villegas"
                            3 => "J&#46;M&#46;D&#46; Rodr&#237;guez"
                            4 => "M&#46;J&#46;G&#46; Velloso"
                            5 => "A&#46;M&#46;G&#46; Vicente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rep Pract Oncol Radiother J Gt Cancer Cent Poznan Pol Soc Radiat Oncol"
                        "fecha" => "2012"
                        "volumen" => "17"
                        "paginaInicial" => "298"
                        "paginaFinal" => "318"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Positron emission tomography with &#91;18F&#93;fluorodeoxyglucose improves staging and patient management in patients with head and neck squamous cell carcinoma&#58; a multicenter prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lonneux"
                            1 => "M&#46; Hamoir"
                            2 => "H&#46; Reychler"
                            3 => "P&#46; Maingon"
                            4 => "C&#46; Duvillard"
                            5 => "G&#46; Calais"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Oncol Off J Am Soc Clin Oncol"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "1190"
                        "paginaFinal" => "1195"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AJCC cancer staging atlas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;C&#46; Compton"
                            1 => "D&#46;R&#46; Byrd"
                            2 => "J&#46; Garcia-Aguilar"
                            3 => "S&#46;H&#46; Kurtzman"
                            4 => "A&#46; Olawaiye"
                            5 => "M&#46;K&#46; Washington"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2<span class="elsevierStyleSup">a</span> ed&#46;"
                        "fecha" => "2012"
                        "editorial" => "Springer-Verlag"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing the value of risk predictions by using risk stratification tables"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Janes"
                            1 => "M&#46;S&#46; Pepe"
                            2 => "W&#46; Gu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2008"
                        "volumen" => "149"
                        "paginaInicial" => "751"
                        "paginaFinal" => "760"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of improved algorithms for the assessment of global cardiovascular risk in women&#58; the Reynolds Risk Score"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;M&#46; Ridker"
                            1 => "J&#46;E&#46; Buring"
                            2 => "N&#46; Rifai"
                            3 => "N&#46;R&#46; Cook"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2007"
                        "volumen" => "297"
                        "paginaInicial" => "611"
                        "paginaFinal" => "619"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT and CT&#47;MRI with histopathologic correlation in patients undergoing salvage surgery for head and neck squamous cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Kim"
                            1 => "J&#46;S&#46; Kim"
                            2 => "J&#46;S&#46; Yi"
                            3 => "J&#46;H&#46; Lee"
                            4 => "S&#46;-H&#46; Choi"
                            5 => "S&#46;Y&#46; Nam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Surg Oncol"
                        "fecha" => "2011"
                        "volumen" => "18"
                        "paginaInicial" => "2579"
                        "paginaFinal" => "2584"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "MUFACE&#46; Gu&#237;a PET-TAC&#46; Protocolo de prescripci&#243;n&#46; Mutualidad General de Funcionarios Civiles del Estado&#59; 2011&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary tumor delineation based on <span class="elsevierStyleSup">18</span>FDG PET for locally advanced head and neck cancer treated by chemo-radiotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Leclerc"
                            1 => "E&#46; Lartigau"
                            2 => "T&#46; Lacornerie"
                            3 => "J&#46;-F&#46; Daisne"
                            4 => "A&#46; Kramar"
                            5 => "V&#46; Gr&#233;goire"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol"
                        "fecha" => "2015"
                        "volumen" => "116"
                        "paginaInicial" => "87"
                        "paginaFinal" => "93"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical evidence on PET-CT for radiation therapy planning in head and neck tumours"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46;G&#46;C&#46; Troost"
                            1 => "D&#46;A&#46;X&#46; Schinagl"
                            2 => "J&#46; Bussink"
                            3 => "W&#46;J&#46;G&#46; Oyen"
                            4 => "J&#46;H&#46;A&#46;M&#46; Kaanders"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol"
                        "fecha" => "2010"
                        "volumen" => "96"
                        "paginaInicial" => "328"
                        "paginaFinal" => "334"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of FDG-PET for defining gross tumor volume of head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Kajitani"
                            1 => "I&#46; Asakawa"
                            2 => "F&#46; Uto"
                            3 => "E&#46; Katayama"
                            4 => "K&#46; Inoue"
                            5 => "T&#46; Tamamoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Radiat Res &#40;Tokyo&#41;"
                        "fecha" => "2013"
                        "volumen" => "54"
                        "paginaInicial" => "671"
                        "paginaFinal" => "678"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Combined <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT imaging in radiotherapy target delineation for head-and-neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Guido"
                            1 => "L&#46; Fuccio"
                            2 => "B&#46; Rombi"
                            3 => "P&#46; Castellucci"
                            4 => "A&#46; Cecconi"
                            5 => "F&#46; Bunkheila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Radiat Oncol Biol Phys"
                        "fecha" => "2009"
                        "volumen" => "73"
                        "paginaInicial" => "759"
                        "paginaFinal" => "763"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "FDG-PET staging and importance of lymph node SUV in head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;J&#46; Kubicek"
                            1 => "C&#46; Champ"
                            2 => "S&#46; Fogh"
                            3 => "F&#46; Wang"
                            4 => "E&#46; Reddy"
                            5 => "C&#46; Intenzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Head Neck Oncol"
                        "fecha" => "2010"
                        "volumen" => "2"
                        "paginaInicial" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleSup">18</span>F FDG PET&#47;CT versus CT&#47;MR imaging and the prognostic value of contralateral neck metastases in patients with head and neck squamous cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;T&#46; Park"
                            1 => "J&#46;-L&#46; Roh"
                            2 => "J&#46;S&#46; Kim"
                            3 => "J&#46;H&#46; Lee"
                            4 => "K&#46;-J&#46; Cho"
                            5 => "S&#46;-H&#46; Choi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2016"
                        "volumen" => "279"
                        "paginaInicial" => "481"
                        "paginaFinal" => "491"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between anatomical cross-sectional imaging and <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in the staging&#44; restaging&#44; treatment response&#44; and long-term surveillance of squamous cell head and neck cancer&#58; a systematic literature overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Evangelista"
                            1 => "A&#46;R&#46; Cervino"
                            2 => "S&#46; Chondrogiannis"
                            3 => "M&#46;C&#46; Marzola"
                            4 => "A&#46;M&#46; Maffione"
                            5 => "P&#46;M&#46; Colletti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nucl Med Commun"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "123"
                        "paginaFinal" => "134"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PET-CT for response assessment and treatment adaptation in head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Bussink"
                            1 => "C&#46;M&#46;L&#46; van Herpen"
                            2 => "J&#46;H&#46;A&#46;M&#46; Kaanders"
                            3 => "W&#46;J&#46;G&#46; Oyen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Oncol"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "661"
                        "paginaFinal" => "669"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The potential advantages of <span class="elsevierStyleSup">18</span>FDG PET&#47;CT-based target volume delineation in radiotherapy planning of head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;N&#46; Moule"
                            1 => "I&#46; Kayani"
                            2 => "S&#46;A&#46; Moinuddin"
                            3 => "K&#46; Meer"
                            4 => "C&#46; Lemon"
                            5 => "K&#46; Goodchild"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Radiother Oncol J Eur Soc Ther Radiol Oncol"
                        "fecha" => "2010"
                        "volumen" => "97"
                        "paginaInicial" => "189"
                        "paginaFinal" => "193"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumor volume delineation in head and neck cancer with 18-fluor-fluorodeoxiglucose positron emission tomography&#58; adaptive thresholding method applied to primary tumors and metastatic lymph nodes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;A&#46; Perez-Romasanta"
                            1 => "M&#46; Bellon-Guardia"
                            2 => "J&#46; Torres-Donaire"
                            3 => "E&#46; Lozano-Martin"
                            4 => "M&#46; Sanz-Martin"
                            5 => "J&#46; Velasco-Jimenez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Transl Oncol"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "283"
                        "paginaFinal" => "293"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modification of staging and treatment of head and neck cancer by FDG-PET&#47;CT prior to radiotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Abramyuk"
                            1 => "S&#46; Appold"
                            2 => "K&#46; Z&#246;phel"
                            3 => "M&#46; Baumann"
                            4 => "N&#46; Abolmaali"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Strahlenther Onkol Organ Dtsch Rontgengesellschaft Al"
                        "fecha" => "2013"
                        "volumen" => "189"
                        "paginaInicial" => "197"
                        "paginaFinal" => "201"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "F-18 FDG PET-CT fusion in radiotherapy treatment planning for head and neck cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Koshy"
                            1 => "A&#46;C&#46; Paulino"
                            2 => "R&#46; Howell"
                            3 => "D&#46; Schuster"
                            4 => "R&#46; Halkar"
                            5 => "L&#46;W&#46; Davis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "2005"
                        "volumen" => "27"
                        "paginaInicial" => "494"
                        "paginaFinal" => "502"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22538089/0000003800000003/v1_201905020850/S225380891830079X/v1_201905020850/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "34047"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003800000003/v1_201905020850/S225380891830079X/v1_201905020850/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380891830079X?idApp=UINPBA00004N"
]