title: Results of a prospective study of positron emission tomography-directed management of residual nodal abnormalities in node-positive head and neck cancer after definitive radiotherapy with or without systemic therapy.
abstract: BACKGROUND
  The purpose of this study was to present our prospectively evaluated positron emission tomography (PET)-directed policy for managing the neck in node-positive head and neck squamous cell carcinoma (N+HNSCC) after definitive radiotherapy (RT) with or without concurrent systemic therapy.
  
  
  METHODS
  One hundred twelve consecutive patients who achieved a complete response at the primary site underwent a 12-week posttherapy nodal response assessment with PET and diagnostic CT. Patients with an equivocal PET underwent a repeat PET 4 to 6 weeks later. Patients with residual CT nodal abnormalities deemed PET-negative were uniformly observed regardless of residual nodal size.
  
  
  RESULTS
  Median follow-up from commencement of RT was 28 months (range, 13-64 months). Residual CT nodal abnormalities were present in 50 patients (45%): 41 PET-negative and 9 PET-positive. All PET-negative residual CT nodal abnormalities were observed without subsequent isolated nodal failure.
  
  
  CONCLUSIONS
  PET-directed management of the neck after definitive RT in node-positive HNSCC appropriately spares neck dissections in patients with PET-negative residual CT nodal abnormalities.
authors.affiliation: Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia. sandro_porceddu@health.qld.gov.au
authors.forename: Sandro V
authors.initials: SV
authors.lastname: Porceddu
authors.forename: David I
authors.initials: DI
authors.lastname: Pryor
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Burmeister
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Burmeister
authors.forename: Michael G
authors.initials: MG
authors.lastname: Poulsen
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Foote
authors.forename: Benedict
authors.initials: B
authors.lastname: Panizza
authors.forename: Scott
authors.initials: S
authors.lastname: Coman
authors.forename: David
authors.initials: D
authors.lastname: McFarlane
authors.forename: William
authors.initials: W
authors.lastname: Coman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009333:Neck; D010610:Pharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D049268:Positron-Emission Tomography; D020266:Radiotherapy, Conformal; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin