title: Volumetric change of human papillomavirus-related neck lymph nodes before, during, and shortly after intensity-modulated radiation therapy.
abstract: BACKGROUND
  To assess volumetric changes of human papillomavirus (HPV)-related lymph nodes (LN) before, during, and after a course of intensity-modulated radiation therapy (IMRT) ± chemotherapy.
  
  
  METHODS
  Each "pathologic" LN (≥1 cm) was contoured on the available diagnostic/planning CTs before, during each week, and after treatment.
  
  
  RESULTS
  Seventy-nine LNs in 50 patients were identified. Beyond the first week of treatment, 3 patterns of LN change were recorded: consistently shrinking LN (n = 33; 41.8%), inconsistently shrinking LN with temporary enlargement limited to the first week (n = 14; 17.7%), or also during the subsequent weeks (n = 32; 40.5%). Nodal density at planning is highly predictive of group assignment, with a larger mean density for consistently over inconsistently shrinking LNs (p = .009). Also, this grouping predicts the response at the end of treatment.
  
  
  CONCLUSIONS
  HPV-related LN behavior during IMRT is extremely variable but somewhat predictable on the basis of nodal density at planning.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA. gsangui1@jhmi.edu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.forename: Francesco
authors.initials: F
authors.lastname: Ricchetti
authors.forename: Binbin
authors.initials: B
authors.lastname: Wu
authors.forename: Nishant
authors.initials: N
authors.lastname: Agrawal
authors.forename: Christine
authors.initials: C
authors.lastname: Gourin
authors.forename: Harold
authors.initials: H
authors.lastname: Agbahiwe
authors.forename: Shanthi
authors.initials: S
authors.lastname: Marur
authors.forename: Stefania
authors.initials: S
authors.lastname: Clemente
authors.forename: Todd
authors.initials: T
authors.lastname: McNutt
authors.forename: Arlene
authors.initials: A
authors.lastname: Forastiere
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000821:virology*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000821:virology*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000821:virology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000821:virology*; D027383:Papillomaviridae / Q000528:radiation effects*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome