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. 2026 Feb;53(3):1498-1508.
doi: 10.1007/s00259-025-07529-z. Epub 2025 Oct 1.

[18F] Fluorodeoxyglucose positron emission tomography/computed tomography scan and liquid biopsy at 12 weeks posttreatment for surveillance of locoregionally advanced nasopharyngeal carcinoma

Li-Ting Liu  1 , Zhen-Chong Yang  2 , Jia-Rui He  1 , Hao-Xiang Long  1 , Ying-Ying Hu  2 , Jia-Yi Shen  3 , Mei-Juan Luo  4 , Yu-Chen Li  1 , Xu Zhang  2 , Su-Chen Li  1 , Zi-Jian Lu  5 , Bei-Bei Xiao  1 , Jin-Hao Yang  1 , Xiao-Fei Lv  4 , Yu-Jing Liang  4 , Shan-Shan Guo  1 , Sai-Lan Liu  1 , Xue-Song Sun  1 , Xiao-Yun Li  1 , Li Yuan  1 , Liang-Ji Li  1 , Guo-Dong Jia  1 , Xue-Bin Xie  6 , Kuok-Wai Iu  6 , Wei Fan  2 , Qiu-Yan Chen  1 , Melvin L K Chua  7 , Hai-Qiang Mai  1 , Lin-Quan Tang  8
Affiliations

[18F] Fluorodeoxyglucose positron emission tomography/computed tomography scan and liquid biopsy at 12 weeks posttreatment for surveillance of locoregionally advanced nasopharyngeal carcinoma

Li-Ting Liu et al. Eur J Nucl Med Mol Imaging. 2026 Feb.

Abstract

Purpose: In nasopharyngeal carcinoma (NPC), the 12-week period following radiotherapy (RT) represents a critical surveillance window for detecting residual disease and distant metastasis. We aim to assess the role of PET/CT And cfEBV DNA levels at 12 weeks post-RT in the surveillance of locoregionally advanced nasopharyngeal carcinoma (LA-NPC).

Methods: Patients with stage III-IVa LA-NPC were included. PET/CT scans were conducted both pre-treatment And at 12 weeks post-RT. cfEBV DNA was assessed pre-treatment, at 4, 12, And 24 weeks post-RT, And subsequently at 3- to 6-month intervals. The primary endpoint was the negative predictive value (NPV) of 12-week PET/CT for identifying locoregional residual disease (RD) and/or distant metastasis (DM).

Results: Between 2018 And 2021, 506 eligible patients were prospectively enrolled (median follow-up: 45.2 months). At 12 weeks post-RT, RD was identified in 22 patients (4.3%), DM in 30 patients (5.9%), And both RD And DM in 6 patients (1.2%). For overall RD and/or DM, 12-week PET/CT demonstrated An NPV of 96.3%, sensitivity of 72.4%, specificity of 93.3%, positive predictive value (PPV) of 58.3%, And accuracy of 90.9%. The corresponding values for 12-week cfEBV DNA were An NPV of 91.7%, sensitivity of 41.7%, specificity of 34.5%, PPV of 93.8%, And accuracy of 87.0%. Among subgroups defined by 12-week cfEBV DNA levels, patients with undetectable cfEBV DNA showed a 96.8% NPV for PET/CT, whereas those with detectable cfEBV DNA demonstrated an 85.0% sensitivity for PET/CT.

Conclusion: PET/CT performed at 12 weeks post-RT is a reliable tool for surveillance in LA-NPC, facilitating the optimization of follow-up strategies and enabling timely therapeutic interventions. The combined use of PET/CT and cfEBV DNA provides valuable risk-stratified insights for managing patients effectively.

Keywords: Circulating cell-free Epstein-Barr virus DNA; Nasopharyngeal carcinoma; Positron emission tomography/computed tomography; Post-treatment surveillance.

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Conflict of interest statement

Declarations. Ethical approval: The study was conducted in accordance with the principles of the Declaration of Helsinki, and the results are reported according to the Consolidated Standards of Reporting Trials guidelines. The trial protocol was approved by the Ethics Review Board of SYSUCC, and written informed consent was obtained from all patients before their participation. Consent to participate: The authors affirm that the patients provided written informed consent prior to the investigations. Consent to publish: The authors affirm that the patients provided written informed consent for publication of data and images. Clinical trial information: NCT number: 03601390. Competing interests: The authors have no relevant financial or non-financial interests to disclose.

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