PET-NECK: a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomography–computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer

Mehanna, Hisham; McConkey, Chris; Rahman, Joy K; Wong, Wai-Lup; Smith, Alison; Nutting, Chris; Hartley, A.; Hall, Peter; Hulme, Claire; Patel, Dharmesh K.; Zeidler, Sandra Ventorin von; Robinson, Max; Sanghera, Bal; Fresco, L.; Dunn, Janet A.

doi:10.3310/hta21170

Cited by 60 publications

(62 citation statements)

References 71 publications

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“…Analysis of Trans Tasman Radiation Oncology Group Study 98.02 demonstrated a zero incidence of isolated neck failures in patients that had a complete clinical and radiographic response [ 18 ]. More recently, Mehanna et al demonstrated that post-CRT PET-CT-guided surveillance showed similar survival outcomes compared to planned neck dissection in those patients with N2 and N3 disease [ 19 ]. In our analysis, we found similar regional control rates in patients that underwent CRT alone with those that went on to receive planned neck dissection.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for patients with head and neck squamous cell carcinoma presenting with N3 nodal disease

et al. 2017

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BackgroundThe present study evaluated clinical outcomes for patients with head and neck squamous cell carcinoma presenting with N3 nodal disease.MethodsA retrospective analysis of N3 head and neck squamous cell carcinoma patients was performed. Pearson chi-square and Wilcoxon signed-rank tests were used to analyze patient demographics, disease characteristics, and treatment variables. Survival was evaluated using Kaplan-Meier curves with the log-rank test. Univariate analysis using Cox proportional hazards models was used to define factors associated with overall survival. Patient and tumor characteristics associated with treatment assignments were analyzed by univariate multinomial logistic regression.ResultsWe identified 36 patients with radiographically-defined N3 disease. For the entire cohort, median follow-up was 23.6 (range 2.8–135.0) months, and overall survival was 60% at 2 years and 30% at 5 years. Overall survival was similar between patients receiving primary surgery, radiotherapy, or chemoradiotherapy (p = 0.10). Primary, regional, and distant control at 5 years was 71%, 66%, and 53%, respectively. There was a trend towards improved regional control with primary surgery (p = 0.07). Planned neck dissection following primary chemoradiotherapy did not improve regional control (p = 0.55). Patients with p16-positive tumors exhibited improved overall (p = 0.05) and metastatic recurrence-free survival (p < 0.05). There were no factors predictive of treatment assignment nor factors associated with overall survival, local and regional control, or distant metastases free-survival on univariate analysis.ConclusionsPatients with N3 head and neck squamous cell carcinoma exhibit 5-year overall survival rates of approximately 30% regardless of treatment modality. Planned neck dissection does not improve regional control in patients undergoing definitive chemoradiotherapy. p16-positive patients represent a favorable cohort. Distant failure comprises the major failure pattern and should be the focus of future studies in improving the outcome of this patient cohort.

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Section: Discussionmentioning

confidence: 99%

Outcomes for patients with head and neck squamous cell carcinoma presenting with N3 nodal disease

et al. 2017

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“…12 This approach, in patients treated nonsurgically with advanced neck disease, has been demonstrated to be more cost-effective with similar survival compared to a planned neck dissection in the posttreatment period. [43][44][45] 2 | CON CLU S IO N The incidence of CUP is increasing but with advances in immunohistochemical staining, imaging, and intraoperative visualization of high-risk subsites has increased the likelihood of identifying the primary site. The PET-CT scans are indicated for CUP before surgical endoscopy and biopsies.…”

Section: Follow-up and Surveillancementioning

confidence: 99%

“…In situations in which there is an inadequate response in the neck from a nonsurgical approach with persistence of a neck mass, a PET‐CT scan can be used with an excellent negative predictive value . This approach, in patients treated nonsurgically with advanced neck disease, has been demonstrated to be more cost‐effective with similar survival compared to a planned neck dissection in the posttreatment period …”

Section: Introductionmentioning

confidence: 99%

AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site

2017

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This article reviews the clinical practice guidelines for head and neck oncology focusing on the management of head and neck cancers of unknown primary (CUP). The primary purpose of this series is to raise awareness of the current guidelines in head and neck oncology by reviewing the recommendations and the evidence supporting such recommendations, particularly those published by the National Comprehensive Cancer Network (NCCN). We review the importance of a thorough history and physical examination, the impact of the American Joint Committee on Cancer (AJCC) eighth edition changes and the importance of immunohistochemistry, the timing and type of imaging, the role of panendoscopy and tonsillectomy (palatine and lingual), and the role of surgery, radiation, and chemotherapy in the primary management of these tumors.

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“…Therefore, clear advantages of PET-CT were determined in a study regarding PET-CT follow-up compared to neck dissection. However, these results only apply to N2 stages and the authors emphasize that it does not seem possible to apply the results to the N3 stage [9,10]. In consideration of the increasingly differentiated approach to different receptor-and gene-associated tumor entities, a study regarding the detection of metastases in "breast cancer" no longer seems up-to-date, for example.…”

Section: Htas In Radiologymentioning

confidence: 99%

“…▶ Table 4 Overview of the number of HTA reports in radiology in the period 2012 -2017, source [23], pg. 594 publication year organ system imaging modality source 2017 breast Mammo, MRI [24] head/neck PET-CT [10] 2016 lung CT [25] lung CT, DCE-CT, FDG-PET-CT [26] all PET-CT, PET-MRI [27] 2015 breast CT [28] abdomen CTC [29] 2014 neuro MR-DWI, CT [30] all MRI [31] 2013 abdomen TE [32] abdomen Sono, CT, MRI [33] 2012 cardio CT-angio, angio [34] CTC -CT-colonography; TEtransient elastography; DCE-CTdynamic contrast-enhanced CT; FDG-PET-CT -18-fluorodeoxyglucose-positron emission tomography; MR-DWImagnetic resonance diffusion-weighted brain imaging; PETpositron emission tomography.…”

Section: Htas: Lack Of Demand Lack Of Supplymentioning

confidence: 99%

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Winkelmann

Neumann

Zeidler

et al. 2019

Fortschr Röntgenstr

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Background Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects. Method This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation” for inpatients and “authorization right” for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies. Results The G-BA’s authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector. Conclusion Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures. Key Points: Citation Format

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Cited by 60 publications

References 71 publications

Outcomes for patients with head and neck squamous cell carcinoma presenting with N3 nodal disease

Outcomes for patients with head and neck squamous cell carcinoma presenting with N3 nodal disease

AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

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