Risk Stratification of Metastatic Neck Nodes by CT and PET in Patients with Head and Neck Cancer Receiving Definitive Radiotherapy

Lin, Ying; Chen, Shang-Wen; Hsieh, T’sang‐T’ang; Yen, Kuo‐Yang; Yang, Shih Neng; Wang, Yao Ching; Kao, Chia Hung

doi:10.2967/jnumed.114.148023

Cited by 16 publications

(18 citation statements)

References 25 publications

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“…In addition, Tang et al revealed, in 2014, that necrosis of metastatic retropharyngeal lymph nodes was a significant independent prognostic factor for DMFS and locoregional relapse-free survival in NPC patients treated with IMRT 29. Lin et al recently reported that radiological lymph node necrosis on CT was an independent risk factor for OS, DFS, and nodal relapse-free survival in patients with HNC treated with IMRT with or without chemotherapy 17, while Lan et al concluded that CNN on MRI was a significant, independent, negative prognostic factor for OS, RRFS, DMFS, and DFS in NPC patients treated with 2D radiotherapy, three-dimensional (3D) radiotherapy, or IMRT 20. However, the patients in most of these studies were treated with 2D or 3D radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Cervical Node Necrosis of Different Grades on the Prognosis of Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

Zhang

Zhou

et al. 2017

J. Cancer

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Background: To analyze the prognostic value of cervical node necrosis (CNN) observed on pretreatment magnetic resonance imaging (MRI) in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).Patients and Methods: The medical records of 1423 NPC patients with cervical node metastasis who underwent IMRT were retrospectively reviewed. Lymph nodes in the axial plane of pretreatment MRI were classified as follows: grade 0 CNN, no hypodense zones; grade 1 CNN, ≤33% areas showing hypodense zones; and grade 2, >33% areas showing hypodense zones.Results: CNN was detectable in 470/1423 (33%) patients. Of these 470 patients, 213 (15%) and 257 (18%) exhibited grade 1 and grade 2 CNN. The grade 0 and grade 1 CNN groups showed significant differences with regard to distant metastasis-free survival (DMFS), but not overall survival (OS), regional relapse-free survival (RRFS), local relapse-free survival (LRFS), and disease-free survival (DFS). Significant differences were observed among the grade 0 and grade 2 CNN groups with regard to OS, RRFS, LRFS, DMFS, and DFS. Moreover, OS, LRFS, RRFS, and DFS were significantly different between the grade 1 and grade 2 CNN groups, whereas DMFS showed no significant differences. Univariate and multivariate analyses revealed CNN on MRI as a significant negative prognostic factor for OS, LRFS, RRFS, DMFS, and DFS in NPC patients.Conclusions: NPC patients with CNN of different grades show various prognosis and failure patterns after IMRT. CNN on MRI can be adopted as a predictive factor for formulating individualized treatment plans for NPC patients.

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Section: Discussionmentioning

confidence: 99%

“…Several previous studies have shown a correlation between the presence of hypodense lymph nodes, which indicate CNN, or CNN on CT and the likelihood of regional failure after radiotherapy and/or chemotherapy in patients with head and neck cancer (HNC), but not NPC 17-19.…”

Section: Introductionmentioning

confidence: 99%

Influence of Cervical Node Necrosis of Different Grades on the Prognosis of Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

Zhang

Zhou

et al. 2017

J. Cancer

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“…The choice of the threshold for either method may affect the absolute value of the MTV. Six studies compared the predictive value of MTV and/or TLG computed with different thresholds (Cheng et al, 2015;Kao et al, 2012;Lin et al, 2015;Schinagl et al, 2011;Yabuki et al, 2015). In the study by (Schinagl et al, 2011), 4 thresholds (2.5, 40%, 50% and adaptive threshold based on liver uptake) were compared for 77 patients treated with RT ± CT. MTV 40% was the strongest predictor of DFS and OS.…”

Section: Suvmax and Metabolic Tumor Volumementioning

confidence: 99%

Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy

Castelli

Bari

Depeursinge

et al. 2016

Critical Reviews in Oncology/Hematology

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International audience18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) allows to quantify the metabolic activity of a tumor (glycolysis) and has become a reference tool in oncology for the staging, restaging, radiotherapy planning and monitoring response in many cancers. Quantitative analyses have been introduced in order to overcome some of the limits of the visual methods, allowing an easier and more objective comparison of the inter- and intra-patients variations. The aims of this review were to report available evidences on the clinical value of quantitative PET/CT parameters in HNC. Forty-five studies, for a total of 2928 patients, were analyzed. Most of the data available dealt with the intensity of the metabolism, calculated from the Standard Uptake Value (SUV). Metabolic Tumor Volume (MTV) was well correlated with overall survival and disease free survival, with a higher predictive value than the maximum SUV. Spatial distribution of metabolism and textural analyses seems promising

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“…Their results showed higher sensitivity respectively for PET/HRCT, PET/CT and HRCT in recurrence detection of their heterogenous patient population [14]. In addition, a few studies comparing the accuracy of these two modalities without accounting for the same day PET/CT and CECT scans have been reported [24–27]. In a prospective trial, Moeller and his colleagues claimed that PET/CT was not superior to CECT scan in therapy assessment of patients with OPSCC.…”

Section: Discussionmentioning

confidence: 99%

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

Taghipour

Mena

Kruse

et al. 2017

Nuclear Medicine Communications

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Objective To compare the accuracy of same day therapy-assessment positron emission tomography/computed tomography (PET/CT) and conventional contrast-enhanced CT (CECT) in patients with oropharyngeal squamous cell carcinoma (OPSCC). Methods 110 patients (95 male and 15 women, mean age 59 years) biopsy-proven OPSCC were evaluated with same day PET/CT and CECT pair scans, as part of follow-up therapy assessment. Scans were performed within 6 months after completion of primary treatment, (median time: 3.1 months, range: 0.5–6 m). PET/CT and CECT scans were retrospectively reviewed for residual primary site disease, and right and left cervical lymph node involvement. Histopathology or 6 month clinical/imaging follow up were used as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for the primary site and cervical nodal disease. Results Of 110 OPSCC patients, 90.9% were HPV positive, 80.8% were stage 4, and 76.4% received chemo-radiation as the primary treatment. The sensitivity, specificity, PPV, NPV and accuracy of PET/CT and CECT were similar in the evaluation of primary cancer site (PET/CT: 75.0, 91.5, 25.0, 99.0 and 90.9, respectively vs CECT: 75.0, 90.6, 23.1, 99.0 and 90.0, respectively). In evaluating cervical lymph node involvement, PET/CT appeared to have higher accuracy (96.8% vs. 81.7%), specificity (97.7% vs. 81.7%) and PPV (45.8% vs. 16.5%), comparable NPV (99.4% for both), and lower sensitivity (65% vs. 75%) as compared to same day CECT. Conclusion Same day PET/CT and CECT scans had comparable accuracy in the evaluation of primary tumor sites after completion of therapy in patients with OPSCC. PET/CT showed higher accuracy in the evaluation of cervical lymph node involvement.

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Risk Stratification of Metastatic Neck Nodes by CT and PET in Patients with Head and Neck Cancer Receiving Definitive Radiotherapy

Cited by 16 publications

References 25 publications

Influence of Cervical Node Necrosis of Different Grades on the Prognosis of Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

Influence of Cervical Node Necrosis of Different Grades on the Prognosis of Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy

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

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