Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer

Christine Gourin, Haydn T. Williams, Wesley N. Seabolt, Anne V. Herdman, Jed W. Howington, David J. Terris

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Planned neck dissection after chemoradiation (CR) is often advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease who demonstrate a clinical complete response to CR because identification of residual occult nodal disease is difficult. We sought to investigate the utility of positron emission tomography-computed tomography (PET-CT) in identifying patients with occult nodal disease after CR. STUDY DESIGN: Nonrandomized retrospective cohort analysis. MATERIALS AND METHODS: The medical records of all patients treated with primary CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2005 were reviewed. Patients with a clinical complete response were eligible for inclusion if PET-CT performed at 8 to 10 weeks after CR showed no evidence of distant disease and they were treated with a planned neck dissection. RESULTS: Seventeen patients met study criteria. PET-CT was positive for residual nodal disease in 11 (64.7%) patients, with a standardized uptake value (SUV) range of 1.7 to 3.8. Pathologic examination revealed residual viable carcinoma in five (29.4%) patients, with tumor size ranging from 2.0 to 9.5 mm. Carcinoma was present in 2 of 11 (18.2%) patients with positive PET-CT scans and 3 of 6 (50%) patients with negative PET-CT scans. The sensitivity and specificity of PET-CT in predicting occult nodal disease was 40% and 25%, respectively. There was no correlation between PET-CT findings and histologic findings (P = .26) or between SUV and size of viable tumor (P = .67). CONCLUSIONS: A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET-CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.

Original languageEnglish (US)
Pages (from-to)705-710
Number of pages6
JournalLaryngoscope
Volume116
Issue number5
DOIs
StatePublished - May 2006
Externally publishedYes

Fingerprint

Head and Neck Neoplasms
Squamous Cell Neoplasms
Neck Dissection
Head
Positron Emission Tomography Computed Tomography
Carcinoma
Medical Records
Neoplasms
Cohort Studies
Neck
Neoplasm Metastasis
Sensitivity and Specificity

Keywords

  • Head and neck neoplasms
  • Neck dissection
  • Nodal metastases
  • PET-CT
  • Squamous cell cancer
  • Treatment

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer. / Gourin, Christine; Williams, Haydn T.; Seabolt, Wesley N.; Herdman, Anne V.; Howington, Jed W.; Terris, David J.

In: Laryngoscope, Vol. 116, No. 5, 05.2006, p. 705-710.

Research output: Contribution to journalArticle

Gourin, Christine ; Williams, Haydn T. ; Seabolt, Wesley N. ; Herdman, Anne V. ; Howington, Jed W. ; Terris, David J. / Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer. In: Laryngoscope. 2006 ; Vol. 116, No. 5. pp. 705-710.
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title = "Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer",
abstract = "OBJECTIVES: Planned neck dissection after chemoradiation (CR) is often advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease who demonstrate a clinical complete response to CR because identification of residual occult nodal disease is difficult. We sought to investigate the utility of positron emission tomography-computed tomography (PET-CT) in identifying patients with occult nodal disease after CR. STUDY DESIGN: Nonrandomized retrospective cohort analysis. MATERIALS AND METHODS: The medical records of all patients treated with primary CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2005 were reviewed. Patients with a clinical complete response were eligible for inclusion if PET-CT performed at 8 to 10 weeks after CR showed no evidence of distant disease and they were treated with a planned neck dissection. RESULTS: Seventeen patients met study criteria. PET-CT was positive for residual nodal disease in 11 (64.7{\%}) patients, with a standardized uptake value (SUV) range of 1.7 to 3.8. Pathologic examination revealed residual viable carcinoma in five (29.4{\%}) patients, with tumor size ranging from 2.0 to 9.5 mm. Carcinoma was present in 2 of 11 (18.2{\%}) patients with positive PET-CT scans and 3 of 6 (50{\%}) patients with negative PET-CT scans. The sensitivity and specificity of PET-CT in predicting occult nodal disease was 40{\%} and 25{\%}, respectively. There was no correlation between PET-CT findings and histologic findings (P = .26) or between SUV and size of viable tumor (P = .67). CONCLUSIONS: A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET-CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.",
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T1 - Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer

AU - Gourin, Christine

AU - Williams, Haydn T.

AU - Seabolt, Wesley N.

AU - Herdman, Anne V.

AU - Howington, Jed W.

AU - Terris, David J.

PY - 2006/5

Y1 - 2006/5

N2 - OBJECTIVES: Planned neck dissection after chemoradiation (CR) is often advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease who demonstrate a clinical complete response to CR because identification of residual occult nodal disease is difficult. We sought to investigate the utility of positron emission tomography-computed tomography (PET-CT) in identifying patients with occult nodal disease after CR. STUDY DESIGN: Nonrandomized retrospective cohort analysis. MATERIALS AND METHODS: The medical records of all patients treated with primary CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2005 were reviewed. Patients with a clinical complete response were eligible for inclusion if PET-CT performed at 8 to 10 weeks after CR showed no evidence of distant disease and they were treated with a planned neck dissection. RESULTS: Seventeen patients met study criteria. PET-CT was positive for residual nodal disease in 11 (64.7%) patients, with a standardized uptake value (SUV) range of 1.7 to 3.8. Pathologic examination revealed residual viable carcinoma in five (29.4%) patients, with tumor size ranging from 2.0 to 9.5 mm. Carcinoma was present in 2 of 11 (18.2%) patients with positive PET-CT scans and 3 of 6 (50%) patients with negative PET-CT scans. The sensitivity and specificity of PET-CT in predicting occult nodal disease was 40% and 25%, respectively. There was no correlation between PET-CT findings and histologic findings (P = .26) or between SUV and size of viable tumor (P = .67). CONCLUSIONS: A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET-CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.

AB - OBJECTIVES: Planned neck dissection after chemoradiation (CR) is often advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease who demonstrate a clinical complete response to CR because identification of residual occult nodal disease is difficult. We sought to investigate the utility of positron emission tomography-computed tomography (PET-CT) in identifying patients with occult nodal disease after CR. STUDY DESIGN: Nonrandomized retrospective cohort analysis. MATERIALS AND METHODS: The medical records of all patients treated with primary CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2005 were reviewed. Patients with a clinical complete response were eligible for inclusion if PET-CT performed at 8 to 10 weeks after CR showed no evidence of distant disease and they were treated with a planned neck dissection. RESULTS: Seventeen patients met study criteria. PET-CT was positive for residual nodal disease in 11 (64.7%) patients, with a standardized uptake value (SUV) range of 1.7 to 3.8. Pathologic examination revealed residual viable carcinoma in five (29.4%) patients, with tumor size ranging from 2.0 to 9.5 mm. Carcinoma was present in 2 of 11 (18.2%) patients with positive PET-CT scans and 3 of 6 (50%) patients with negative PET-CT scans. The sensitivity and specificity of PET-CT in predicting occult nodal disease was 40% and 25%, respectively. There was no correlation between PET-CT findings and histologic findings (P = .26) or between SUV and size of viable tumor (P = .67). CONCLUSIONS: A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET-CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.

KW - Head and neck neoplasms

KW - Neck dissection

KW - Nodal metastases

KW - PET-CT

KW - Squamous cell cancer

KW - Treatment

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