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

Christine Gourin, Brian J. Boyce, Hadyn T. Williams, Anne V. Herdman, Paul A. Bilodeau, Teresa A. Coleman

Research output: Contribution to journalArticle

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 PETCT 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.

Original languageEnglish (US)
Pages (from-to)2150-2155
Number of pages6
JournalLaryngoscope
Volume119
Issue number11
DOIs
StatePublished - Nov 2009

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Neck Dissection
Head and Neck Neoplasms
Squamous Cell Neoplasms
Positron Emission Tomography Computed Tomography
Head
Unnecessary Procedures
Recurrence
Medical Records
Pathology
Carcinoma

Keywords

  • Head and neck neoplasms
  • Neck dissection
  • Nodal metastases
  • Positron-emission tomography/computed tomography
  • Squamous cell cancer
  • Treatment

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

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. / Gourin, Christine; Boyce, Brian J.; Williams, Hadyn T.; Herdman, Anne V.; Bilodeau, Paul A.; Coleman, Teresa A.

In: Laryngoscope, Vol. 119, No. 11, 11.2009, p. 2150-2155.

Research output: Contribution to journalArticle

Gourin, Christine ; Boyce, Brian J. ; Williams, Hadyn T. ; Herdman, Anne V. ; Bilodeau, Paul A. ; Coleman, Teresa A. / 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. In: Laryngoscope. 2009 ; Vol. 119, No. 11. pp. 2150-2155.
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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 PETCT 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.",
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AU - Williams, Hadyn T.

AU - Herdman, Anne V.

AU - Bilodeau, Paul A.

AU - Coleman, Teresa A.

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AB - 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 PETCT 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.

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