Image-Guided PET-CT Surveillance Can Be as Effective as Neck Dissection for Advanced Head and Neck Cancer

The use of the different techniques for the treatment of patients with advanced head and neck squamous-cell carcinoma nodal disease (stage N2 or N3) who have undergone chemoradiotherapy for primary treatment, is unclear and under debate.

The primary end point of the prospective, randomized, controlled trial was to assess overall survival rates, and the non-inferiority of Positron-Emission Tomography-Computed Tomography (PET-CT) guided surveillance when compared with planned neck dissection for patients with stage N2 or N3 carcinoma nodal disease.

The researchers used data gathered by the UK Warwick Clinical Trials Unit. Tissue samples were collected and stained for the p16 protein at the University of Birmingham (Birmingham, UK). The study lasted from 2007 to 2012, and included 564 patients from 37 centers in the UK. Seventeen percent of the patients had nodal stage N2a disease, while 61% had stage N2b disease.

The results showed that the use of PET-CT guided surveillance resulted in significantly less neck dissections (54) compared to planned dissection surgery (221). Surgical complications were similar in both groups. The 2-year overall survival rate was 84.9% for those patients undergoing PET-CT surveillance, and 81.5% for those that underwent planned-surgery. In addition, savings of UKP 1,492 per patient were realized per patient, for the duration of the trial, when PET-CT guided surveillance was used instead of neck dissection.

The researchers concluded that survival rates for patients who underwent planned neck dissection were similar to those that underwent PET-CT guided surveillance, and that imaging surveillance resulted in significantly less operations than neck dissection, and was more cost-effective.

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University of Birmingham