PURPOSE: To determine how to use node response on computed tomography (CT) to indicate the need for neck dissection. PATIENTS AND METHODS: Five hundred fifty patients with lymph node-positive head and neck cancer were treated between 1990 and 2002 with radiotherapy (RT) at a median dose of 74.4 Gy; 24% of these patients (n = 133) were treated with chemotherapy. Three hundred forty-one patients (62%) underwent planned post-RT neck dissection. Physical examination and contrast-enhanced CT were performed 30 days after completion of RT. CT images were reviewed in 211 patients for lymph node size (largest axial dimension) and presence of a focal abnormality (lucency, enhancement, or calcification). By correlating post-RT CT to neck dissection pathology, criteria associated with a low likelihood of residual disease were identified. A subset of patients who fit these criteria of radiographic response who did not undergo post-RT neck dissection was observed for recurrence. RESULTS: Radiographic complete response (rCR) was defined as the absence of any large (> 1.5 cm) or focally abnormal lymph node. Correlation of response with neck dissection pathology indicated a negative predictive value of 77% for complete clinical response and 94% for rCR. In 32 patients (median follow-up time, 3.2 years) with rCR who did not undergo post-RT neck dissection, the 5-year ultimate neck control rate (100%) and cause-specific survival rate (72%) were not significantly different from the rates of patients with a negative post-RT neck dissection. CONCLUSION: Patients with rCR 4 weeks after RT can be spared from a post-RT neck dissection regardless of initial node stage.
PURPOSE: To determine how to use node response on computed tomography (CT) to indicate the need for neck dissection. PATIENTS AND METHODS: Five hundred fifty patients with lymph node-positive head and neck cancer were treated between 1990 and 2002 with radiotherapy (RT) at a median dose of 74.4 Gy; 24% of these patients (n = 133) were treated with chemotherapy. Three hundred forty-one patients (62%) underwent planned post-RT neck dissection. Physical examination and contrast-enhanced CT were performed 30 days after completion of RT. CT images were reviewed in 211 patients for lymph node size (largest axial dimension) and presence of a focal abnormality (lucency, enhancement, or calcification). By correlating post-RT CT to neck dissection pathology, criteria associated with a low likelihood of residual disease were identified. A subset of patients who fit these criteria of radiographic response who did not undergo post-RT neck dissection was observed for recurrence. RESULTS: Radiographic complete response (rCR) was defined as the absence of any large (> 1.5 cm) or focally abnormal lymph node. Correlation of response with neck dissection pathology indicated a negative predictive value of 77% for complete clinical response and 94% for rCR. In 32 patients (median follow-up time, 3.2 years) with rCR who did not undergo post-RT neck dissection, the 5-year ultimate neck control rate (100%) and cause-specific survival rate (72%) were not significantly different from the rates of patients with a negative post-RT neck dissection. CONCLUSION:Patients with rCR 4 weeks after RT can be spared from a post-RT neck dissection regardless of initial node stage.
Authors: Juliette Thariat; K Kian Ang; Pamela K Allen; Anesa Ahamad; Michelle D Williams; Jeffrey N Myers; Adel K El-Naggar; Lawrence E Ginsberg; David I Rosenthal; Bonnie S Glisson; William H Morrison; Randal S Weber; Adam S Garden Journal: Int J Radiat Oncol Biol Phys Date: 2012-03-01 Impact factor: 7.038
Authors: Alexandra Lucs; Benjamin Saltman; Christine H Chung; Bettie M Steinberg; David L Schwartz Journal: Head Neck Date: 2012-01-27 Impact factor: 3.147
Authors: Benjamin J Moeller; Vishal Rana; Blake A Cannon; Michelle D Williams; Erich M Sturgis; Lawrence E Ginsberg; Homer A Macapinlac; J Jack Lee; K Kian Ang; K S Clifford Chao; Gregory M Chronowski; Steven J Frank; William H Morrison; David I Rosenthal; Randal S Weber; Adam S Garden; Scott M Lippman; David L Schwartz Journal: Int J Radiat Oncol Biol Phys Date: 2010-02-18 Impact factor: 7.038
Authors: S S Yom; A S Garden; G A Staerkel; L E Ginsberg; W H Morrison; E M Sturgis; D I Rosenthal; J N Myers; B S Edeiken-Monroe Journal: AJNR Am J Neuroradiol Date: 2011-07-14 Impact factor: 3.825
Authors: J D Hamilton; S Ahmed; V C Sandulache; S P Daram; T J Ow; H D Skinner; A Rao; L E Ginsberg; A J Kumar; J N Myers Journal: AJNR Am J Neuroradiol Date: 2013-03-07 Impact factor: 3.825