Positron emission tomography-computed tomography surveillance for the node-positive neck after chemoradiotherapy

Area of Science:

• Oncology
• Radiology
• Head and Neck Surgery

Background:

• Advanced head and neck squamous cell carcinoma (HNSCC) requires careful post-treatment surveillance.
• Nonsurgical therapy, including chemoradiotherapy, is a common treatment modality for HNSCC.
• Accurate assessment of residual neck disease is crucial for guiding further management decisions.

Purpose of the Study:

• To evaluate the efficacy of positron emission tomography and computed tomography fusion imaging (PET-CT) for surveillance of the postchemoradiotherapy neck in advanced HNSCC patients.
• To determine the diagnostic performance of PET-CT in detecting residual neck disease.

Main Methods:

• Retrospective analysis of 52 patients with advanced HNSCC treated with nonsurgical therapy.
• Post-treatment neck surveillance using PET-CT imaging.
• Calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT.

Main Results:

• PET-CT identified residual neck disease in 10 patients and negative scans in 42 patients.
• The negative predictive value (NPV) and positive predictive value (PPV) of PET-CT were 100% and 40%, respectively.
• Sensitivity, specificity, and accuracy of PET-CT were 100%, 87.5%, and 88%, respectively.

Conclusions:

• A negative post-treatment PET-CT scan supports deferring planned neck dissection in advanced HNSCC.
• Serial PET-CT surveillance may be a viable option for patients with residual palpable cervical lymphadenopathy after complete primary site response.
• PET-CT demonstrates high accuracy in assessing residual neck disease following chemoradiotherapy.