Comparison Between PET-CT–Guided Neck Dissection and Elective Neck Dissection in cT1-2N0 Tongue Squamous Cell Carcinoma

Abstract

Objective: Neck management in cT1-2N0 tongue squamous cell carcinoma (SCC) remains controversial. Our goal was to compare the survival difference between PET-CT-guided neck dissection and elective neck dissection (END) for the treatment of cT1-2 tongue SCC. Methods: Patients with surgically treated cT1-2N0 tongue SCC were retrospectively enrolled. These patients were divided into two groups. Group A: The decision of whether to perform neck dissection was mainly based on the results of preoperative PET-CT examinations. Group B: Patients received END treatment without preoperative PET-CT examinations. The study endpoints were regional control (RC) and disease-specific survival (DSS). The Kaplan-Meier method was used to calculate the survival rates. Results: Group A consisted of 66 patients, and 16 patients underwent neck dissection owing to positive PET-CT results. Group B consisted of 169 patients. The 5-year RC rates in group A and group B were 86 and 87%, respectively, and the difference was not significant (p = 0.731). The 5-year DSS rates in group A and group B were 93 and 90%, respectively, and the difference was not significant (p = 0.583). Conclusions: Neck dissection can be safely avoided when the PET-CT scan reveals no neck lymph node involvement.

18F-FDG PET/CT Staging of Head and Neck Cancer: Interobserver Agreement and Accuracy—Results from Multicenter ACRIN 6685 Clinical Trial

“…In this study we have provided evidence that multiple readers can achieve high NPV by visual assessment as well as by SUVmax analysis. This result has significant implications, especially managing the contralateral neck, as single center studies have now reported on the outcome of patients managed with observation of PET directed (negative) contralateral neck [10,11].…”

A Rational Approach to Unilateral Neck RT for Head and Neck Cancers in the Era of Immunotherapy

“…Most studies are limited by heterogeneous treatment, poorly described RT, and selection bias. Yet the reported contralateral neck failure rates in the absence of contralateral neck RT in these selected patients with pN0-2a surgical staging are reassuring, ranging from 0–12% [ 83 , 84 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ]. While no single risk factor appears to be independently and reliably associated with nodal recurrence, increasing the depth of invasion appears to confer the highest risk when combined with additional risk factors [ 83 ].…”