Premium
Revisiting the role of positron‐emission tomography/computed tomography in determining the need for planned neck dissection following chemoradiation for advanced head and neck cancer
Author(s) -
Gourin Christine G.,
Boyce Brian J.,
Williams Hadyn T.,
Herdman Anne V.,
Bilodeau Paul A.,
Coleman Teresa A.
Publication year - 2009
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20523
Subject(s) - medicine , positron emission tomography , occult , neck dissection , radiology , dissection (medical) , head and neck cancer , head and neck squamous cell carcinoma , nuclear medicine , chemoradiotherapy , cancer , radiation therapy , pathology , alternative medicine
Abstract Objectives/Hypothesis: Planned neck dissection following chemoradiation (CR) has been advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease and a clinical complete response to CR because of the potential for residual occult nodal disease. The utility of positron‐emission tomography/computed tomography (PET‐CT) in identifying occult nodal disease in this scenario is controversial. Methods: The medical records of all patients treated with CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2007 were reviewed. Patients with a complete clinical response were included if PET‐CT performed 8 to 11 weeks after CR showed no distant disease and they underwent planned neck dissection. Results: Thirty‐two patients met study criteria. PET‐CT was positive for residual nodal disease in 20 patients (63%). Pathology revealed carcinoma in 10 patients (31%): six of 20 patients with positive PET‐CT scans (30%) and four of 12 patients with negative PET‐CT scans (33%). The sensitivity and specificity of PET‐CT was 60% and 36%. Regional recurrence developed in two patients (6%) who were not successfully salvaged. Conclusions: PET‐CT performed 8 to 11 weeks after CR does not reliably predict the need for planned post‐treatment neck dissection in patients with a complete clinical response following CR. Regional recurrence rates are comparable to those reported for patients observed with PET‐CT, suggesting no advantage for planned neck dissection, and salvage rates were poor. These data suggest that delaying the timing of PET‐CT, with surgery reserved for positive findings, is a reasonable alternative to planned neck dissection to avoid unnecessary surgery. Laryngoscope, 2009