Imaging strategy for response evaluation to chemoradiotherapy of the nodal disease in patients with head and neck squamous cell carcinoma

Background Definitive chemoradiotherapy (CRT) is used to treat lymph node metastatic head and neck cancer patients. Regional control of the neck disease is important to improve the prognosis, and the accuracy of the method used to evaluate the metastatic lymph node(s) after CRT is crucial to the dec...

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Bibliographic Details
Published in:International journal of clinical oncology 2016-08, Vol.21 (4), p.658-667
Main Authors: Nishimura, Goshi, Yabuki, Kenichiro, Hata, Masaharu, Komatsu, Masanori, Taguchi, Takahide, Takahashi, Masahiro, Shiono, Osamu, Sano, Daisuke, Arai, Yasuhiro, Takahashi, Hideaki, Chiba, Yoshihiro, Oridate, Nobuhiko
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biopsy, Fine-Needle
Cancer Research
Carcinoma, Squamous Cell - diagnostic imaging
Carcinoma, Squamous Cell - secondary
Carcinoma, Squamous Cell - therapy
Chemoradiotherapy
Chemotherapy
Female
Fluorodeoxyglucose F18
Head & neck cancer
Head and Neck Neoplasms - diagnostic imaging
Head and Neck Neoplasms - pathology
Head and Neck Neoplasms - therapy
Humans
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Lymphatic Metastasis
Lymphatic system
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Metastasis
Middle Aged
Oncology
Original Article
Positron-Emission Tomography
Prognosis
Radiation therapy
Radiopharmaceuticals
Retrospective Studies
Sensitivity and Specificity
Surgical Oncology
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography
Young Adult
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Summary:Background Definitive chemoradiotherapy (CRT) is used to treat lymph node metastatic head and neck cancer patients. Regional control of the neck disease is important to improve the prognosis, and the accuracy of the method used to evaluate the metastatic lymph node(s) after CRT is crucial to the decision-making process for any following salvage surgery. Methods Patients undergoing CRT were divided in two groups of patients of those showing complete clinical response (CR) and those showing clinical non-response (non-CR), as assessed by computed tomography (CT) and/or magnetic resonance imaging (MRI), ultrasonography, fluorodeoxyglucose-positron emission tomography (FDG-PET), and fine needle aspiration cytology. The responses (CR vs. non-CR) were compared with the actual clinical outcomes. For the interim analysis, the study period was broken down into two periods, namely, the exploratory phase (patients treated between January 2002 and April 2012) and the validating phase (patients treated between May 2012 and January 2014). Results The sensitivity, specificity, and accuracy were as follows: CT and/or MRI, 66.7, 73.8, and 72.8 %, respectively, in the exploratory phase; ultrasonography, 91.7, 70.6, and 73.4 %, respectively, in the exploratory phase and 80.0, 82.8, and 82.4 %, respectively, in the validating phase; FDG-PET, 50.0, 97.5, and 91.3 %, respectively, in the exploratory phase and 60.0, 100, and 94.1 %, respectively, in the validating phase; cytology, 68.4, 95.9, and 90.3 %, respectively, in the exploratory phase and 66.7, 100, and 85.7 %, respectively, in the validating phase. Conclusions Based on our results, CT and/or MRI appear to be inadequate methods for the evaluation of the response of lymph node(s) to CRT. In contrast, ultrasonography appears to be a highly sensitive and useful tool for positive screening at 6–8 weeks after CRT, and FDG-PET appears to be a highly specific and useful tool for negative screening at 8–12 weeks after CRT.
ISSN:1341-9625
1437-7772
DOI:10.1007/s10147-015-0936-y