Ability of Positron Emission Tomography to Detect Residual Neck Node Disease in Patients With Head and Neck Squamous Cell Carcinoma After Definitive Chemoradiotherapy

Authors:
  • DADavid J. Adelstein
    David J. Adelstein
  • LRLisa A. Rybicki
    Lisa A. Rybicki
  • JSJerrold P. Saxton
    Jerrold P. Saxton
  • RERamon M. Esclamado
    Ramon M. Esclamado
  • BWBenjamin G. Wood
    Benjamin G. Wood
  • RLRobert R. Lorenz
    Robert R. Lorenz
  • MSMarshall Strome
    Marshall Strome
  • MCMarjorie A. Carroll
    Marjorie A. Carroll
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Abstract
In patients with head and neck squamous cell cancer, optimal management of the neck after definitive concurrent chemoradiotherapy is controversial. It is standard practice to perform at least a selective neck dissection in patients with residual palpable nodes or computed tomographic (CT) evidence of suspicious lymphadenopathy after completion of treatment. However, controversy arises about the role of neck dissection in the subset of patients with N2 or greater disease at presentation who have achieved a complete clinical and radiologic response to chemoradiotherapy. Based on the high response rates seen and the low risk of isolated neck failure after chemoradiotherapy, some recommend expectant management alone for these patients.1-6 However, others advocate a planned neck dissection in all patients with N2 or N3 disease at diagnosis regardless of their clinical response to treatment.7-13 This approach is supported by investigations7-13 showing the presence of residual viable cancer in neck nodes even in those patients considered to have achieved a complete response, as well as by evidence of a lower rate of regional disease recurrence and improved survival in patients undergoing neck dissection. It also recognizes the lower success rate of salvage surgery when occult nodal disease becomes clinically manifest.14,15

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