Purpose/Objective(s): Metastatic spread to parotid area lymph nodes (PALN) occurs in 1-3% of patients with cutaneous squamous cell carcinoma (SCCa) of the head and neck. We present the University of Florida experience in using radiation therapy (RT) to treat patients with PALN metastases from a skin primary. parotids in 117 patients received irradiation for non-melanotic skin carcinoma metastatic to PALN. Patients were staged by the O'Brien staging system. Of the 121 parotids receiving RT, 17 (14%) were treated preoperatively, 87 (72%) postoperatively, and 17 with RT alone. Results: Five-year actuarial probabilities of local (parotid) control, local-regional control, disease-free survival, and overall survival were 78%, 74%, 70%, and 54%, respectively. Statistically significant differences were seen between groups for local (parotid) control, local-regional control, and disease-free survival when patients were separated by P-stage. A statistically significant decrease in local control was seen in patients treated with positive surgical margins (92% vs. 76%), and in local-regional control for patients treated with preoperative RT or RT alone compared to postoperative RT (59% and 47% vs. 83%, respectively). The 5-year actuarial probability of freedom from distant metastases was 92%. Three (2.6%) patients suffered severe complications. Conclusions: PALN metastases from a cutaneous head and neck primary site are best treated with surgery and postoperative RT. Our data support the hypothesis that the O'Brien staging system is superior to the American Joint Committee on Cancer (AJCC) system for the staging of cutaneous metastases to PALN. Positive surgical margins confer a worse prognosis in terms of local-regional control and disease-free survival. Patients treated with preoperative RT appear to have a worse prognosis than those treated postoperatively, likely a result of patient selection and the surgeon's inability to accurately assess viable tumor extent after preoperative RT. Severe complications are uncommon following surgery and RT for PALN metastases.
Purpose-We previously showed that metabolic tumor volume (MTV) on PET-CT predicts for disease recurrence and death in head and neck cancer (HNC). We hypothesized that increases in MTV over time would correlate with tumor growth and biology, and predict outcome. We sought to examine tumor growth over time in serial pre-treatment PET-CT scans. [2006][2007][2008][2009] 51 patients had two PET-CT scans prior to HNC treatment. MTV was defined as the tumor volume ≥50% of maximum SUV (SUV max ). MTV was calculated for the primary tumor, nodal disease, and composite (primary tumor + nodes). MTV and SUV velocity were defined as the change in MTV or SUV max over time respectively. Cox regression analyses were used to examine correlations between SUV, MTV velocity, and outcome (disease progression and overall survival [OS]). Methods and Materials-FromResults-Median follow-up time was 17.5 months. Median time between PET-CT scans was 3 weeks. Unexpectedly, 51% of cases demonstrated a decrease in SUV max (average −0.1cc/week) and MTV (average −0.3cc/week) over time. Despite the variability in MTV, primary tumor MTV velocity predicted disease progression (hazard ratio [HR] 2.94; p=0.01), and OS (HR 1.85; p=0.03). Conclusions-Primarytumor MTV velocity appears to be a better prognostic indicator of disease progression and survival compared to nodal MTV velocity. However, substantial variability was found in PET-CT biomarkers between serial scans. Caution should be used when integrating PET-CT biomarkers into clinical protocols in HNC.Keywords metabolic tumor volume; functional imaging; head and neck cancers; PETCT
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