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Results of a prospective study of positron emission tomography–directed management of residual nodal abnormalities in node-positive head and neck cancer after definitive radiotherapy with or without systemic therapy

Authors

  • Sandro V. Porceddu MBBS, MD, FRANZCR,

    Corresponding author
    1. Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia
    2. University of Queensland, St. Lucia, Queensland, Australia
    • Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia
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  • David I. Pryor MBBS, FRANZCR,

    1. Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia
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  • Elizabeth Burmeister BN, MSc,

    1. Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia
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  • Bryan H. Burmeister MB ChB, MD, FRANZCR,

    1. Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia
    2. University of Queensland, St. Lucia, Queensland, Australia
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  • Michael G. Poulsen MBBS, FRANZCR,

    1. University of Queensland, St. Lucia, Queensland, Australia
    2. Mater Hospital, Radiation Oncology Service, Brisbane, Queensland, Australia
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  • Matthew C. Foote MBBS, FRANZCR,

    1. Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia
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  • Benedict Panizza MBBS, FRACS,

    1. University of Queensland, St. Lucia, Queensland, Australia
    2. Princess Alexandra Hospital, Head and Neck Surgical Service, Brisbane, Queensland, Australia
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  • Scott Coman MBBS, FRACS,

    1. Princess Alexandra Hospital, Head and Neck Surgical Service, Brisbane, Queensland, Australia
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  • David McFarlane MBBS, FRACP,

    1. Royal Brisbane Hospital, PET Centre, Brisbane, Queensland, Australia
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  • William Coman MBBS, FRACS

    1. University of Queensland, St. Lucia, Queensland, Australia
    2. Princess Alexandra Hospital, Head and Neck Surgical Service, Brisbane, Queensland, Australia
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  • This work was accepted for oral presentation at the 52nd American Society for Therapeutic Radiology and Oncology (ASTRO) Annual Meeting, San Diego, California, 2010.

Abstract

Background

The purpose of this study was to present our prospectively evaluated positron emission tomography (PET)-directed policy for managing the neck in node-positive head and neck squamous cell carcinoma (N+HNSCC) after definitive radiotherapy (RT) with or without concurrent systemic therapy.

Methods

One hundred twelve consecutive patients who achieved a complete response at the primary site underwent a 12-week posttherapy nodal response assessment with PET and diagnostic CT. Patients with an equivocal PET underwent a repeat PET 4 to 6 weeks later. Patients with residual CT nodal abnormalities deemed PET-negative were uniformly observed regardless of residual nodal size.

Results

Median follow-up from commencement of RT was 28 months (range, 13–64 months). Residual CT nodal abnormalities were present in 50 patients (45%): 41 PET-negative and 9 PET-positive. All PET-negative residual CT nodal abnormalities were observed without subsequent isolated nodal failure.

Conclusion

PET-directed management of the neck after definitive RT in node-positive HNSCC appropriately spares neck dissections in patients with PET-negative residual CT nodal abnormalities. © 2011 Wiley Periodicals, Inc. Head Neck, 2011

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