The role of imaging in the surveillance of patients with node-positive advanced-stage head and neck cancer is unclear, and whether patients should undergo a planned neck dissection following primary chemoradiation treatment is controversial. In a prospective, randomized, controlled trial, investigators assessed the noninferiority of PET–CT-guided surveillance to planned neck dissection in patients with stage N2 or N3 nodal disease. At a median follow up of 36 months, PET–CT resulted in fewer neck dissections than planned surgery (54 versus 221). Moreover, the hazard ratio for death slightly favoured PET–CT-guided surveillance, and indicated noninferiority of surveillance compared with planned neck dissection. Survival was similar among patients who underwent PET–CT-guided surveillance and those who had a planned neck dissection; however, surveillance resulted in considerably fewer operations and was more cost-effective, with a saving of UK£1,492 per patient over the course of the trial.
References
Mehanna, H. et al. PET–CT surveillance versus neck dissection in advanced head and neck cancer. N. Engl. J. Med. 374, 1444–1454 (2016)
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Hutchinson, L. Reducing neck dissection via PET–CT surveillance. Nat Rev Clin Oncol 13, 328 (2016). https://doi.org/10.1038/nrclinonc.2016.71
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DOI: https://doi.org/10.1038/nrclinonc.2016.71