The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment

Min Yao, Russell B. Smith, Michael M. Graham, Henry T. Hoffman, Huaming Tan, Gerry F. Funk, Scott M. Graham, Kristi Chang, Kenneth J. Dornfeld, Yusuf Menda, John M. Buatti

Research output: Contribution to journalArticlepeer-review

142 Scopus citations

Abstract

Purpose: The role of neck dissection after definitive radiation for head-and-neck cancer is controversial. We select patients for neck dissection based on postradiation therapy (post-RT), computed tomography (CT), and [ 18F] fluorodeoxyglucose positron emission tomography (FDG PET). We summarize the clinical outcomes of patients treated with this policy to further elucidate the role of FDG PET in decision making for neck dissection after primary radiotherapy. Methods and Materials: Between December 1999 and February 2004, 53 eligible patients were identified. These patients had stage N2A or higher head-and-neck squamous cell carcinoma and had complete response of the primary tumor after definitive radiation with or without chemotherapy. PET or computed tomography (CT) scans were performed within 6 months after treatment. Neck dissection was performed in patients with residual lymphadenopathy (identified by clinical examination or CT) and a positive PET scan. Those without residual lymph nodes and a negative PET were observed without neck dissection. For patients with residual lymphadenopathy, but a negative PET scan, neck dissection was performed at the discretion of the attending surgeon and decision of the patient. There was a total of 70 heminecks available for analysis (17 patients had bilateral neck disease). Results: There were 21 heminecks with residual lymphadenopathy identified on CT imaging or clinical examination and negative PET. Of these, 4 had neck dissection and were pathologically negative. The remaining 17 were observed without neck dissection. There was a total of 42 heminecks without residual lymph nodes on post-RT CT imaging or clinical examination with a negative PET. They were also observed without neck dissection. Seven heminecks had a positive PET scan and residual lymphadenopathy. Six of them had neck dissection and 1 had fine-needle aspiration of a residual node; 3 contained residual viable cancer and 4 were pathologically negative. At median follow up of 26 months (range, 12-57 months), no regional failure was identified. The negative predictive value of PET was 100% and positive predictive value was 43%. Conclusion: For patients who have no evidence of residual lymphadenopathy and a negative FDG PET scan 12 weeks after definitive radiation, neck dissection can be safely withheld. Even in cases in which small residual lymphadenopathy was observed, regional recurrences have not occurred when the post-RT PET scan was negative and neck dissection was withheld. For patients with large residual lymphadenopathy (greater than 2.0-3.0 cm in size) but a negative post-RT FDG PET, further studies with longer follow-up are necessary to determine the appropriateness of withholding neck dissection.

Original languageEnglish (US)
Pages (from-to)991-999
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume63
Issue number4
DOIs
StatePublished - Nov 15 2005

Keywords

  • FDG PET
  • Head-and-neck cancer
  • Planned neck dissection
  • Radiation

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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