The role of PET in head and neck cancer: More than ¹⁸FDG alone

Positron emission tomography (PET) is a functional imaging modality that is widely used in oncology. The integration of PET with CT (PET/CT) has provided at the same time detailed morphological information, which is especially attractive for the anatomically complex head and neck region. In this overview, the more established role of ¹⁸FDG-PET in management of head and neck cancer is discussed, focusing on its pros and cons for staging of disease and for treatment response prediction and monitoring. ¹⁸FDG is not the ideal tracer for all these applications, and therefore several novel metabolic PET-trac-ers are presented. In addition, new fields of PET application are forecasted. Hypoxia is a common phenomenon in head and neck cancer and is associated with a poor response to (chemo)radiotherapy. Therefore, knowledge of hypoxia may influence treatment decisions. Several candidate hypoxia PET-tracers are discussed. With the increasing knowledge of critical molecular targets in head and neck cancer (e.g. the epidermal growth factor receptor), many novel targeted anticancer therapeutics become available among which monoclonal antibodies and tyrosin kinase inhibitors. Upon labeling of these drugs with a positron emitter, their distribution within the human body can be quantitatively imaged by PET. In this way, PET can be used for guidance of drug development and appropriate treatment selection for the individual patient (personalized medicine).