Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: The role of US,MRI and FDG-PET/TC scans to assess residual neck disease |
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| Affiliation: | 1. Department of Otolaryngology – Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Italy;2. Department of Radiology, National Cancer Institute Regina Elena, Rome, Italy;3. Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Italy;4. Department of Nuclear Medicine, National Cancer Institute Regina Elena, Rome, Italy;5. Department of Pathology, National Cancer Institute Regina Elena, Rome, Italy;6. Department of Biostatistics, National Cancer Institute Regina Elena, Rome, Italy;1. Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia University, Nazloo Road, Urmia 57153 1177, Iran;2. Department of Clinical Sciences, Faculty of Veterinary Medicine, Urmia Branch, Islamic Azad University, Urmia, Iran;3. Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4, Canada;1. Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy;2. Medical Oncology, Ospedale San Donato, Istituto Toscano Tumori, Arezzo, Italy;3. Biostatistics, Regina Elena National Cancer Institute, Roma, Italy;4. Medical Oncology, Regina Elena National Cancer Institute, Roma, Italy;5. Medical Oncology, Policlinico Universitario Campus Bio-Medico, Roma, Italy;6. Medical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;7. Medical Oncology, Santa Chiara Hospital, Trento, Italy;1. Department of Plastic and Reconstructive Surgery, Chiba University, Graduate School of Medicine, Japan;2. Department of Neurosurgery, Showa University, Japan;1. School of Electrical, Electronic and Communication Engineering, College of Engineering and Architecture, Communication and Optoelectronic Research Centre, The SFI-Strategic Research Cluster in Solar Energy Conversion, University College Dublin, Belfield, Dublin 4, Ireland;2. Department of Electronic Engineering, The Callan Institute, National University of Ireland Maynooth, County Kildare, Ireland;1. Division of Oncology, Complesso Ospedaliero Belcolle, AUSL Viterbo, Viterbo, Italy;2. Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy;3. Medical Oncology Unit, ASL Frosinone, Frosinone, Italy;4. Department of Medical, Oral and Biotechnological Sciences, University G. d''Annunzio, Chieti, Italy;5. Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy;6. Oncology Unit, Sant''Andrea Hospital, Sapienza University of Rome, Rome, Italy;7. Oncology Unit, IDI – I.R.C.C.S., Rome, Italy;8. Medical Oncology, Policlinico Universitario Campus Bio-Medico, Roma, Italy;9. Department of Medical Oncology, San Camillo and Forlanini Hospitals Rome, Italy;10. Biostatistics, Regina Elena National Cancer Institute, Roma, Italy;11. Division of Oncology, Sandro Pertini Hospital, Rome, Italy;12. Division of Oncology, San Giovanni Hospital, Rome, Italy;13. Medical Oncology Unit, SS. Annunziata Hospital, Chieti, Italy;14. Department of Oncology and Haematology, Azienda Ospedaliera Policlinico, Modena, Italy;1. Department of Plastic and Reconstructive surgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Republic of Korea;2. Department of Plastic and Reconstructive surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, Republic of Korea |
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| Abstract: | ObjectiveTo investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).MethodsFrom 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique.ResultsMetastatic disease was assessed in 18/37 (48.6%) hemi-necks, always localized in levels II–IV. US showed greater sensitivity (77.8%) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3%). US, MRI and FDG-PET/TC scans showed the highest specificity (100%), accuracy (93.8%) and positive predictive values (100%).ConclusionsIn the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended. |
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| Keywords: | Oropharyngeal cancer Chemoradiotherapy Planned neck dissection FDG-PET–CT Neck ultrasound |
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