alexa Timing of Restaging PET/CT and Neck Dissection after Chemoradiation for Advanced Head and Neck Squamous Cell Carcinoma | OMICS International| Abstract
ISSN: 2161-119X

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  • Research Article   
  • Otolaryngology 2013, Vol 3(1): 128
  • DOI: 10.4172/2161-119X.1000128

Timing of Restaging PET/CT and Neck Dissection after Chemoradiation for Advanced Head and Neck Squamous Cell Carcinoma

Marietta Tan1, Carole Fakhry1,5, Katherine Fan1, David Zaboli1, Geoffrey Neuner2, Eva S Zinreich2, Marshall A Levine3,4, Mei Tang4, Ray G Blanco5, John R Saunders5, Joseph A Califano1,5, Milton J Dance5 and Patrick K Ha1,5*
1Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Medical Institutions, , Baltimore, Maryland, USA
2Department of Radiation Oncology, Sandra and Malcolm Berman Cancer Institute, Greater Baltimore Medical Center, , Baltimore, Maryland, USA
3Johns Hopkins University School of Medicine, , Baltimore, Maryland, USA
4Department of Medical Oncology, Sandra and Malcolm Berman Cancer Institute, Greater Baltimore Medical Center, , Baltimore, Maryland, USA
5Head and Neck Center, Greater Baltimore Medical Center, , Baltimore, Maryland, USA
*Corresponding Author : Patrick K Ha MD FACS, Associate Professor, Johns Hopkins Department of Otolaryngology, Johns Hopkins Head and Neck Surgery at GBMC, 1550 Orleans St, Rm 5M06, David H Koch Cancer Research Building, Baltimore, MD 21231, USA, Tel: 410-502-5144, Fax: 410-614-1411, Email: [email protected]

Received Date: Feb 06, 2013 / Accepted Date: Feb 12, 2013 / Published Date: Feb 15, 2013

Abstract

Background: Concomitant chemoradiation therapy (CRT) is widely accepted as a primary treatment of advanced head and neck squamous cell carcinoma (HNSCC). However, controversy exists regarding the treatment of patients with no clinically evident nodal disease after CRT. PET/CT imaging has therefore become increasingly popular to aid in the selection of patients who would benefit from post-CRT neck dissection. However, there are several competing concerns regarding the timing of PET/CT and planned neck dissection. The aims of this study were to assess how (i) the detection of residual neck disease by PET/CT and (ii) the incidence of viable carcinoma in neck dissection specimens differ with time after CRT for advanced HNSCC.


Methods: Retrospective review of 121 patients who underwent PET/CT and planned neck dissection following
primary CRT for N2 or greater HNSCC. The sensitivity and specificity of PET/CT for detection of residual neck disease after CRT were determined. Rates of negative, non-viable, or positive pathologic results in neck dissection specimens were also assessed.


Results: PET/CT results following CRT were analyzed for a total of 116 neck sides. The sensitivity and specificity of PET/CT for residual neck disease were 42.3% and 90.4%, respectively. Specificity tended to increase with time, whereas sensitivity decreased. Sixty patients underwent planned neck dissection earlier than 12 weeks following mcompletion of CRT, and 61 patients underwent neck dissection 12 weeks or later. Viable carcinoma was detected in 31.4% of surgical specimens. Rates of negative, non-viable, or positive pathologic results were similar in neck dissections performed before versus after 12 weeks following CRT (p=0.951).
 

Conclusions: PET/CT is limited by low predictive value, but specificity tends to increase with time. Rates of viable carcinoma do not differ with time; histologic evidence of tumor lysis does not appear to continue beyond 12 weeks after CRT.

Citation: Tan M, Fakhry C, Fan K, Zaboli D, Neuner G, et al. (2013) Timing of Restaging PET/CT and Neck Dissection after Chemoradiation for Advanced Head and Neck Squamous Cell Carcinoma. Otolaryngology 3:128. Doi: 10.4172/2161-119X.1000128

Copyright: © 2013 Tan M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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