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
Gourin CG et al. - In a study to assess the use of positron-emission tomography/computed tomography (PET-CT) in identifying occult nodal disease for planned neck dissection following chemoradiation for advanced head and neck squamous cell cancer (HNSCC), the 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. Methods- Medical records of all pts treated with chemoradiation (CR) for advanced HNSCC with N2 or N3 disease were reviewed.
- Pts with a complete clinical response were included if PET-CT performed 8 to 11 wks after CR showed no distant disease and they underwent planned neck dissection.
Results- 32 pts met study criteria.
- PET-CT was positive for residual nodal disease in 20 pts (63%).
- Pathology revealed carcinoma in 10 pts (31%): 6 of 20 pts with positive PET-CT scans (30%) and 4 of 12 pts with negative PET-CT scans (33%).
- Sensitivity and specificity of PET-CT was 60% and 36%.
- Regional recurrence developed in 2 pts (6%) who were not successfully salvaged.
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