Definitive radiotherapy for head-and-neck cancer with radiographically positive retropharyngeal nodes: Incomplete radiographic response does not necessarily indicate failure (original) (raw)
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Cancer, 2019
original draft, and writing-review and editing. Courtney Pollard III: data curation, investigation, visualization and writing-review and editing. Joel Berends: data curation, and writing-review and editing. Zeina Ayoub: data curation, and writing-review and editing. Mona Kamal: data curation, and writing-review and editing. Adam S Garden: investigation, methodology, writing-review and editing, Precis: Routine clinical surveillance with imaging is frequently obtained at fixed intervals as determined by institutional or departmental policy. Our study showed that surveillance imaging in asymptomatic patients treated definitively Houda Bahig: data curation, investigation and writing-review and editing, Scott B Cantor: methodology and writing-review and editing Andrew J Schaefer: methodology and writing-review and editing,
American Journal of Neuroradiology
BACKGROUND AND PURPOSE: The NI-RADS lexicon doesn't use ADC parameters and T2 weighted signal for ascribing categories. We explored ADC, DWI, and T2WI to examine the diagnostic accuracy in primary sites of postsurgical oral cavity carcinoma in the Neck Imaging Reporting and Data System (NI-RADS) categories 2 and 3. MATERIALS AND METHODS: We performed a retrospective analysis in clinically asymptomatic post-surgically treated patients with oral cavity squamous cell carcinoma who underwent contrast-enhanced MRI between January 2013 and January 2016. Histopathology and follow-up imaging were used to ascertain the presence or absence of malignancy in subjects with "new enhancing lesions," which were interpreted according to the NI-RADS lexicon by experienced readers, including NI-RADS 2 and 3 lesions in the primary site. NI-RADS that included T2WI and DWI (referred to as NI-RADS A) and ADC (using the best cutoff from receiver operating characteristic curve analysis, NI-RADS B) was documented in an Excel sheet to up-or downgrade existing classic American College of Radiology NI-RADS and calculate diagnostic accuracy. RESULTS: Sixty-one malignant and 23 benign lesions included in the study were assigned American College of Radiology NI-RADS 2 (n ¼ 33) and NI-RADS 3 (n ¼ 51) categories. The recurrence rate was 90% (46/51) for NI-RADS three, 45% (15/33) for NI-RADS 2, and 73% (61/84) overall. T2WI signal morphology was intermediate in 45 subjects (53.5%) and restricted DWI in 54 (64.2%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the American College of Radiology NI-RADS were the following:
Multi detector computerized tomography scans aid in the staging of Head and Neck cancers
Brazilian Journal of Oral Sciences, 2017
Introduction/Objectives: To assess the efficacy and correlation of MDCT scans in the clinical staging of patients with HNCs prior to therapeutic intervention. Methodology: Thirty-four HNCs were studied according to the 2005 WHO. Clinical AJCC 6th edition & radiological staging. Results: 14 Squamous Cell Carcinoma (SCC 41.2%) mean age 49.4 + 14.7 years, 13 Nasopharyngeal Carcinoma (NPC 38.2%) mean age 37.1 + 20.5 years, 3 Odontogenic Carcinoma (ODC 8.8% made up of 2 cases ameloblastic carcinoma 5.9% and 1 case of ameloblastic carcinosarcoma 2.9%). Others cases were 3 Adenocarcinoma (8.8%) and 1 Sinonasal Carcinoma NC (2.9%). Mean age insignificant according to gender (p = 0.342). Sensitivity, specificity, positive & negative predictive values and accuracy of clinical and radiological nodal involvements were: (47.4%; 80%; 61.8%; 75%; 54.5%) & (78.9%; 93.3%; 85.3%; 93.8%; 77.8%) respectively. Difference between clinical and radiological stages was statistically significant (X2= 260.8; p=0.01). There was a low but positive correlation between the clinical and radiologic stages (Pearson's correlation r = 0.6). Conclusion: MDCT was significantly more accurate than clinical examination in the TNM of HNCs using AJCC/UICC TNM guidelines. Authors recommend MDCT as first line imaging technique in resource limited settings.
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,
Laryngoscope, 2005
Purpose In patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with 18 F-FDG PET-CT or no imaging at all. Methods This study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used. Results Of the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with 18 F-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N = 168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as first event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the different staging methods had no significant impact on the DRFI. Conclusions This study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically significant impact of the different imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using 18 F-FDG PET-CT over conventional imaging techniques.
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: To determine whether findings on CT studies, done 6 weeks after radiotherapy (RT), can predict the likelihood of ultimate control at the primary site in oropharyngeal carcinoma. Methods and Materials: Forty-six patients with oropharyngeal squamous cell carcinoma underwent RT with curative intent. A minimal 2-year clinical follow-up after RT was required. The primary site CT findings were graded for risk of recurrence on a modified 3-point scale as follows: Grade 0, no detectable focal abnormalities; Grade 1, anatomic asymmetry or focal mass <1 cm; Grade 2, focal mass >10 mm (2a) or <50% shrinkage of the mass as seen on pretreatment studies (2b). Results: No patients with CT findings of Grade 0 (n ؍ 26) or Grade 1 (n ؍ 5) had a primary site recurrence. One of the 13 patients with CT findings of Grade 2a had a primary site recurrence 1 year after completion of RT. None of the 2 patients with CT findings of Grade 2b had a primary site recurrence. Ultimately, 45 of the 46 patients in this study group had disease control at the primary site. Conclusion: In the evaluation of oropharyngeal squamous cell carcinoma on post-RT CT studies, diffuse and symmetric post-RT changes of the soft tissue or asymmetry without detectable mass or a discrete mass <10 mm always indicated ultimate control at the primary site. Even when post-RT CT shows a discrete mass >10 mm at the primary site, the likelihood of local control is high (93%). The study results indicate that CT findings, based on this relatively small series, may not add incremental information beyond that of clinical examination for predicting local control but may be useful as a baseline if imaging surveillance is contemplated.
Advances in Modern Oncology Research, 2017
Accurate tumor diagnosis is important in highly conformal techniques such as Intensity Modulated radiotherapy (IMrT), which aims for high therapeutic ratio. We compared gross Tumor Volume (gTV) (primary and nodal) delineated on 18 F-fluorodeoxyglucose positron emission tomography ([ 18 F]-FDg-PeT) scan to those delineated on contrast-enhanced computed tomography (CeCT) scan and its impact on staging treated by IMrT. A total of 30 consecutive patients with locally advanced squamous cell carcinoma of head and neck were included in this study. FDg-PeT and CeCT scans were performed with dedicated positron emission tomography-computed tomography (PeT/CT) scanner in a single session as part of radiotherapy treatment planning for IMrT. After treatment with concurrent chemoradiotherapy, all patients were followed for one year. Three out of 30 patients were excluded from the final analysis, as there was complete remission in PET/CT after neoadjuvant chemotherapy. For remaining 27 cases, the primary sites were 17 oropharynx, 2 hypopharynx, 7 larynx and 1 unknown primary with secondary neck node. PeT-CT resulted in changes of CT-based staging in 25% patients (upstaged in 3 and down-staged in 4). gTV delineated on PeT vs. CT scan was gTV-PeT (primary) of 20.15 cm 3 vs. gTV-CT (primary) of 18.75 cm 3 , p = 0.803; and gTV-PeT (nodes) of 28.45 cm 3 vs. gTV-CT (nodes) of 21.56 cm 3 , p = 0.589. The mismatch between two target volumes was statistically insignificant (p = 0.635 for gTV primary, p = 0.187 for nodes). The mean gTV-PeT outside CT for primary was 5.83 cm 3 , and for node was 8.47 cm 3. Median follow-up was 12 months. Oneyear loco-regional control was 92%. The target delineation of GTV can be improved with functional imaging [ 18 F]-FDg-PeT/ CT.