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
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
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DOI：
10.1002/lary.20523
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发表时间：
2009-11-01
期刊：
影响因子：
2.6
通讯作者：
Coleman, Teresa A.
中科院分区：
文献类型：
--
作者：
Gourin, Christine G.;Boyce, Brian J.;Coleman, Teresa A.
目的/假设：在患有头颈部鳞状细胞癌（HNSCC）的晚期淋巴结疾病患者中，由于存在残留隐匿性淋巴结疾病的可能性，主张在CR临床完全缓解的患者中进行计划性颈清扫术（CR）。正电子发射断层扫描/计算机断层扫描（PET-CT）在确定隐匿性淋巴结疾病在这种scenario.Methods：CR治疗的所有患者的病历与晚期HNSCC与N2或N3疾病从2003年12月至2007年6月进行了审查。完全临床反应的患者包括，如果PET-CT进行8至11周后CR显示没有远处疾病，他们接受了计划的颈清扫术。结果：32例符合研究标准。PET-CT对20例患者（63%）的残留淋巴结疾病呈阳性。10例患者（31%）的病理学显示为癌：20例PET-CT扫描阳性患者中有6例（30%），12例PET-CT扫描阴性患者中有4例（33%）。PET-CT诊断的敏感性为60%，特异性为36%。区域复发的两名患者（6%）谁没有成功savaged.Conclusions：PET-CT进行CR后8至11周不可靠预测需要计划治疗后颈部淋巴结清扫术的患者完全临床反应CR。局部复发率与PET-CT观察到的患者报告的复发率相当，表明计划性颈清扫术无优势，挽救率较差。这些数据表明，延迟PET-CT的时间，手术保留阳性结果，是一个合理的替代计划颈淋巴结清扫术，以避免不必要的手术。
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.