Head and Neck

Revisiting the role of positron-emission tomography/computed tomography in determining the need for planned neck dissection following chemoradiation for advanced head and neck cancer†

  1. Christine G. Gourin MD, FACS1,*,
  2. Brian J. Boyce BS2,
  3. Hadyn T. Williams MD3,
  4. Anne V. Herdman MD4,
  5. Paul A. Bilodeau MD5,
  6. Teresa A. Coleman MD5

Article first published online: 18 JUN 2009

DOI: 10.1002/lary.20523

Issue

The Laryngoscope

The Laryngoscope

Volume 119, Issue 11, pages 2150–2155, November 2009

Additional Information

How to Cite

Gourin, C. G., Boyce, B. J., Williams, H. T., Herdman, A. V., Bilodeau, P. A. and Coleman, T. A. (2009), Revisiting the role of positron-emission tomography/computed tomography in determining the need for planned neck dissection following chemoradiation for advanced head and neck cancer. The Laryngoscope, 119: 2150–2155. doi: 10.1002/lary.20523

Author Information

  1. 1

    Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland

  2. 2

    Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia

  3. 3

    Department of Radiology, Medical College of Georgia, Augusta, Georgia

  4. 4

    Pathology Associates, Erlanger Medical Center, Chattanooga, Tennessee

  5. 5

    Department of Medicine, Medical College of Georgia, Augusta, Georgia, U.S.A.

*Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline Street, Suite 6260, Baltimore, MD 21287

  1. †

    Presented at the Triological Society 112th Annual Meeting at COSM, Phoenix, Arizona, U.S.A., May 29, 2009.

Publication History

  1. Issue published online: 22 OCT 2009
  2. Article first published online: 18 JUN 2009
  3. Manuscript Accepted: 7 APR 2009

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Keywords:

  • Positron-emission tomography/computed tomography;
  • nodal metastases;
  • treatment;
  • squamous cell cancer;
  • head and neck neoplasms;
  • neck dissection

Abstract

Objectives/Hypothesis:

Planned neck dissection following chemoradiation (CR) has been advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease and a clinical complete response to CR because of the potential for residual occult nodal disease. The utility of positron-emission tomography/computed tomography (PET-CT) in identifying occult nodal disease in this scenario is controversial.

Methods:

The medical records of all patients treated with CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2007 were reviewed. Patients with a complete clinical response were included if PET-CT performed 8 to 11 weeks after CR showed no distant disease and they underwent planned neck dissection.

Results:

Thirty-two patients met study criteria. PET-CT was positive for residual nodal disease in 20 patients (63%). Pathology revealed carcinoma in 10 patients (31%): six of 20 patients with positive PET-CT scans (30%) and four of 12 patients with negative PET-CT scans (33%). The sensitivity and specificity of PET-CT was 60% and 36%. Regional recurrence developed in two patients (6%) who were not successfully salvaged.

Conclusions:

PET-CT performed 8 to 11 weeks after CR does not reliably predict the need for planned post-treatment neck dissection in patients with a complete clinical response following CR. Regional recurrence rates are comparable to those reported for patients observed with PET-CT, suggesting no advantage for planned neck dissection, and salvage rates were poor. These data suggest that delaying the timing of PET-CT, with surgery reserved for positive findings, is a reasonable alternative to planned neck dissection to avoid unnecessary surgery. Laryngoscope, 2009

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