Ability of Positron Emission Tomography to Detect Residual Neck Node Disease in Patients With Head and Neck Squamous Cell Carcinoma After Definitive Chemoradiotherapy

Abstract

To report our experience using the neck examination, computed tomography (CT), and positron emission tomography (PET) to clinically evaluate nodepositive patients with head and neck squamous cell cancer for residual neck node disease after definitive chemoradiotherapy. Design: Retrospective review of all Cleveland Clinic patients with head and neck squamous cell cancer and N2 or N3 neck node involvement at presentation who were treated with definitive concurrent chemoradiotherapy and who underwent clinical restaging after treatment using the neck examination, CT, and PET. Setting: Tertiary care referral institution. Patients: Forty-eight patients with 72 positive necks at diagnosis were followed up for a median of 20 months. Main Outcome Measures: Palpable nodes on examination, nodes larger than 1 cm, nodes with central necrosis on CT, or any hypermetabolic lymph nodes on PET were considered clinical evidence of residual nodal disease. The true rate of pathologic involvement was determined by histologic examination after planned neck dissection or if regional recurrence developed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for all 3 clinical assessment tools.

The role of positron emission tomography/CT imaging in head and neck cancer patients after radical chemoradiotherapy

“…It is recognised that a negative PET/CT after CRT may allow omission of the neck dissection, avoiding unnecessary surgery and all the associated risks and potential morbidity [7][8][9][10][11][12][13]. The data from this study are consistent with prior studies in confirming this finding.…”

Post-treatment 18F-FDG-PET/CT versus contrast-enhanced CT in patients with oropharyngeal squamous cell carcinoma

“…Authors also claimed that the sensitivity of PET/CT was higher for those scans performed later from the treatment completion [20]. Our results were very similar to those studies that only included the post treatment scan within 6 months of therapy completion [21,22]. …”

Role of Planned Postchemoradiotherapy Selective Neck Dissection in the Multimodality Management of Head and Neck Cancer

“…The present study confirms earlier findings that in patients with advanced neck disease at presentation, the incidence of residual cervical metastasis after successful primary site treatment with chemoradiotherapy approaches 40% 8–10 . Furthermore, despite advances in imaging techniques, the pathologic status of the neck cannot as yet, in our view, be wholly reliably predicted from clinical and radiologic investigations 8,11–13 . In the present series, hemineck disease control rates in patients with viable and nonviable neck disease were 73% and 100%, respectively, with only one patient dying of neck disease.…”

“…8 -10 Furthermore, despite advances in imaging techniques, the pathologic status of the neck cannot as yet, in our view, be wholly reliably predicted from clinical and radiologic investigations. 8,[11][12][13] In the present series, hemineck disease control rates in patients with viable and nonviable neck disease were 73% and 100%, respectively, with only one patient dying of neck disease. The overall hemineck disease control rate of 92% achieved for N 2-3 disease stands in contrast with the 63% neck control rate after a "wait and watch" policy for N 2 -only disease.…”