Chest computerized tomography scanning in patients presenting with head and neck cancer

Abstract

Between 1 to 16% of patients with head and neck squamous cell carcinoma (HNSCC) have synchronous tumours; the majority (> 50%) occurring within the lung. Previous studies have relied upon endoscopy and chest radiographs. The aim of this study was to determine the incidence of synchronous intrapulmonary tumours in this group of patients using computerized tomography (CT) scanning. Over 36 months, 111 consecutive patients were assessed at presentation by contrast enhanced CT scanning from the skull base to the diaphragm. Chest scans showed intrapulmonary lesions in 17 patients and 10 have, with time, been confirmed as neoplastic. These allowed treatment of three primary bronchial carcinomas following radical treatment of the index tumour and cancellation of radical treatment in five patients with metastases. Two patients with possible metastases at presentation underwent radical treatment to the index tumour with subsequent follow-up confirming metastatic chest disease. All 10 patients eventually died of either locoregional or metastatic disease. This is one of the first prospective reports of chest scanning in patients with head and neck cancer. An additional chest scan in this group, many of whom undergo a staging scan of the neck, requires an extra 10 min with no further contrast and in this study yielded a synchronous tumour rate of 9%.

Efficacy of Radiologic Screening for Distant Metastases and Second Primaries in Newly Diagnosed Patients With Head and Neck Cancer

“…Only two patients had positive screening results without chest abnormalities. Corresponding prevalences have been reported in the literature and range between 3.5% and 21.1% (median, 17.4%) 5,7–13 . A number of them are distinctly higher than that found in the present analysis, which may be explained by selection of high‐risk patients in many studies.…”

“…Other authors limited the use of scanning and recommended conventional chest x‐ray for the remaining patients. The criteria by which patients should be selected for thoracic CT scan included presence of advanced primary tumors 15 ; evidence of bulky, bilateral, or low jugular lymph node involvement 5,7,15 ; and proposal of major “quality‐of‐life impact” surgery 7,8 . Application of bone scintigraphy or abdominal ultrasound is not suggested in any of these papers.…”

Screening Tests to Evaluate Distant Metastases in Head and Neck Cancer

“…This may, at least in part, be explained by the very low prevalence of positive findings in both studies. Overall the evidence strongly supports the view that CT scan is currently the single most sensitive diagnostic technique for the detection of distant metastases to the thorax and should therefore be the preferred investigation, at least in high-risk patients [3,10,15]. In addition to pulmonary metastases, CT scan also detects mediastinal lymph node metastases, primary lung cancer and bone metastases in the vertebrae and ribs [3].…”

Strategies for patients with newly diagnosed oral squamous cell carcinoma and a positive chest CT. A cohort study on the effects on treatment planning and incidence

“…[9,10] Also patients with locally advanced or recurrent tumor show more distant metastasis. [11,12,13,14,15,16] It is this riskassessment the guideline is based upon. The current Dutch guideline does not consider a diagnostic search for a synchronous second tumor in all HNSCC patients due to the low incidence.…”

“…The added value of a chest CT is either detecting a lung carcinoma in a curable stage or scaling down the treatment of the index tumor in case of an incurable lung carcinoma or distant metastasis. [12,19] Known disadvantages of scanning patients with a low risk of distant metastasis are the radiation dose, unnecessary costs and delay in treatment start of the index tumors in case of false positive findings. [20] The current study was initiated to investigate the value of a CT scan of the chest in newly diagnosed SCC of the oral cavity irrespective the tumor stage.…”