title: The role of computed tomography in the management of the neck after chemoradiotherapy in patients with head-and-neck cancer.
abstract: OBJECTIVE
  The aim of this study was to describe the outcome in patients with head-and neck-squamous cell carcinoma (HNSCC) followed up without neck dissection (ND) after concomitant chemoradiotherapy (CRT) based on computed tomography (CT) response. The second objective was to establish CT characteristics that can predict which patients can safely avoid ND.
  
  
  METHODS
  Between 1998 and 2007, 369 patients with node-positive HNSCC were treated with primary CRT at our institution. After a clinical and a radiologic evaluation based on CT done 6 to 8 weeks after CRT, patients were labeled with a complete neck response (CR) or with a partial neck response (PR).
  
  
  RESULTS
  The median follow-up was 44 months. The number of patients presenting with N3, N2, or N1 disease were 54 (15%), 268 (72%), and 47 (13%), respectively. After CRT, 263 (71%) patients reached a CR, and 253 of them did not undergo ND. Ninety-six patients reached a PR and underwent ND. Of those, 34 (35%) had residual disease on pathologic evaluation. A regression of the diameter of ≥ 80% and a residual largest diameter of 15 mm of nodes had negative pathologic predictive values of 100% and 86%, respectively. The 3-year regional control and survival rates were not different between patients with CR who had no ND and patients with PR followed by ND.
  
  
  CONCLUSIONS
  Node-positive patients presenting a CR as determined by CT evaluation 6 to 8 weeks after CRT had a low rate of regional recurrence without ND. This study also suggests that lymph node residual size and percentage of regression on CT after CRT may be useful criteria to guide clinical decisions regarding neck surgery. Those results can help diminish the number of ND procedures with negative results and their associated surgical complications.
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada. sebastien.clavel@umontreal.ca
authors.forename: Sébastien
authors.initials: S
authors.lastname: Clavel
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Charron
authors.forename: Manon
authors.initials: M
authors.lastname: Bélair
authors.forename: Guila
authors.initials: G
authors.lastname: Delouya
authors.forename: Bernard
authors.initials: B
authors.lastname: Fortin
authors.forename: Philippe
authors.initials: P
authors.lastname: Després
authors.forename: Denis
authors.initials: D
authors.lastname: Soulières
authors.forename: Edith
authors.initials: E
authors.lastname: Filion
authors.forename: Louis
authors.initials: L
authors.lastname: Guertin
authors.forename: Phuc Felix
authors.initials: PF
authors.lastname: Nguyen-Tan
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003657:Decision Making; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000628:therapy; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012074:Remission Induction; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil