Utilizing PET-CT scans following treatment for patients with head and neck cancer that has spread to their lymph nodes significantly reduces the need for invasive follow-up surgery. These results were recently published in the New England Journal of Medicine.
Patients diagnosed with head and neck cancer (HNC) that has spread to nearby lymph nodes are often initially treated with a combination of chemotherapy and radiation therapy (chemoradiation). Following treatment, patients then undergo a type of surgery referred to as neck dissection to remove any remaining cancer cells within the lymph nodes in the neck.
The neck dissection surgical procedure is considered an invasive intervention that requires a follow-up hospital stay, and can result in significant side effects.
Researchers recently conducted a clinical trial to determine if surveillance using a positron-emission tomography-computed tomography (PET-CT)- guided scan performed at 12 weeks following completion of chemoradiation therapy could help discern which patients would benefit from neck dissection.
The trial was performed from 2007 through 2012 and included 564 patients with HNC that had spread to their local lymph nodes. One group of patients received PET-CT surveillance and only underwent neck dissection if the scan indicated the presence of cancer cells within the lymph nodes. The other group of patients underwent the standard neck dissection following therapy without a prior scan (control group). The median follow-up was 36 months.
- At 2 years, overall survival was 84.9% among patients who underwent PET-CT surveillance, and 81.5% among patients in the control group.
- Only 19% of patients who underwent PET-CT surveillance underwent neck dissection (due to the notable presence of cancer cells on the surveillance scan), compared with 78% in the control group.
- Quality of life was similar between the two groups of patients.
The researchers concluded that surveillance with PET-CT significantly reduces the rates of neck dissection surgery without compromising survival among patients with HNC whose cancer spread to nearby lymph nodes. This approach may provide a promising change in follow-up care for patients with this disease.
Reference: Mehanna H, Wong W-L, McConkey C, et al. PET-CT Surveillance versus neck dissection in advanced head and neck cancer. New England Journal of Medicine. 2016; 374:1444-1454. DOI: 10.1056/NEJMoa1514493.
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