Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: the role of US, MRI and FDG-PET/TC scans to assess residual neck disease (original) (raw)
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International Journal of Cancer, 2013
Traditionally, patients treated with chemoradiotherapy for node-positive oropharyngeal squamous cell carcinoma (N+ OPSCC) have undergone a planned neck dissection (ND) after treatment. Recently, negative post-treatment positron-emission tomography (PET)/computed tomography (CT) imaging has been found to have a high negative predictive value for the presence of residual disease in the neck. Here we present the first comprehensive analysis of a large, uniform cohort of N+ OPSCC patients achieving a PET/CT-based complete response (CR) after chemoradiotherapy, and undergoing observation, rather than ND. From 2002 to 2009, 302 patients with N+ OPSCC treated with 70 Gy intensity-modulated radiation therapy and concurrent chemotherapy underwent post-treatment clinical assessment including PET/CT. CR was defined as no evidence of disease on clinical examination and post-treatment PET/CT. ND was reserved for patients with <CR on either PET/CT, clinical examination, or other imaging. 260 patients (86.1%) had clinical and radiographic CRs, and underwent neck observation (rate of regional control, 97.7%; 5-year overall survival, 79.8%). The four observed patients experiencing neck recurrence had initial staging of N1 (n=2), N2b (n=1), and N2c (n=1). Three of four were successfully surgically salvaged. There was no association between N stage and rate of neck recurrence (P = 0.74). 52% and 25% of patients undergoing ND had viable tumor in the neck after positive and negative PET/CT,
Head & Neck, 2016
Background. The purpose of this study was to test if diffusion-weighted imaging (DWI) identified persistent neck disease after chemoradiotherapy (CRT) for oropharyngeal cancer earlier and as accurately as subsequent positron emission tomography (PET)/CT. Methods. We performed a review of patients with oropharyngeal cancer treated with definitive CRT who underwent DWI and PET/CT at a median of 8 and 14 weeks posttreatment. Imaging characteristics were correlated with pathologically proven neck failure. Results. Forty-one patients and 58 hemi-necks were analyzed. With a median follow-up of 120 weeks, 4 neck failures were identified. The apparent diffusion coefficient (ADC) of lymph node failures was lower (1220 vs 1910 lm 2 /s; p 5 .003) than non-failures. Using an ADC threshold of 1500 lm 2 /s, the sensitivity, specificity, and positive and negative predictive values (PPV; NPV) were 100% (4/4), 92% (46/50), 50% (4/8), and 100% (46/46) for DWI, respectively, and 100% (3/3), 71% (22/31), 25% (3/12), and 100% (22/22) for PET/CT, respectively. Conclusion. Earlier DWI produced similar sensitivity and better specificity in identifying persistent neck disease as 3-month PET/CT. V
PLoS ONE, 2014
The clinical usefulness of pretreatment imaging techniques for predicting neck control in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) treated with chemoradiation remains unclear. In this prospective study, we investigated the role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI), diffusion-weighted MR imaging (DWI), and [ 18 F]fluorodeoxyglucose-positron emission tomography (18 F-FDG PET)/CT derived imaging markers for the prediction of neck control in OHSCC patients treated with chemoradiation. Patients with untreated OHSCC scheduled for chemoradiation between August, 2010 and July, 2012 were eligible for the study. Clinical variables and the following imaging parameters of metastatic neck lymph nodes were examined in relation to neck control: transfer constant, volume of blood plasma, and
Head & Neck, 2013
Background. The purpose of this study was to assess whether a positron emission tomography (PET)-directed policy remains appropriate for managing neck nodes (N3; >6 cm) in head and neck squamous cell carcinoma (HNSCC). Methods. All patients with N3 (>6 cm) HNSCC treated with definitive chemoradiotherapy (CRT) at our institution between 2005 and 2012 were included in the analysis. Patients underwent PET assessment before and 12 weeks after CRT. Neck dissections were performed for PET-avid residual nodal abnormalities after complete response at the primary site. Rate of isolated nodal failure (INF) was the primary outcome.
Laryngoscope, 2009
Objective: To establish the feasibility of positron emission tomography and computerized tomography (PET-CT) protocols for the management of the post chemoradiotherapy neck in community settings. Study Design: Retrospective. Methods: Four hundred twenty-eight patients with advanced head neck squamous cell carcinoma were treated with non-surgical therapy at a community cancer center from September 2002 to March 2007 and followed with post-treatment PET-CT surveillance of the neck. Fifty-two patients meeting inclusion criteria were analyzed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT were determined. Results: Ten patients had a positive post-treatment PET-CT for residual neck disease, and 42 patients had negative scans. The NPV and PPV were 100% and 40%, respectively. The sensitivity, specificity, and accuracy were 100%, 87.5%, and 88% respectively. Conclusions: Planned neck dissection can be deferred with a negative post-treatment PET-CT. Our results are comparable to those in current literature and validate the feasibility of PET-CT imaging protocols in community-based cancer centers.