title: Outcomes after primary chemoradiotherapy for N3 (>6 cm) head and neck squamous cell carcinoma after an FDG-PET--guided neck management policy.
abstract: BACKGROUND
  The purpose of this study was to assess whether a positron emission tomography (PET)-directed policy remains appropriate for managing neck nodes (N3; >6 cm) in head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  All patients with N3 (>6 cm) HNSCC treated with definitive chemoradiotherapy (CRT) at our institution between 2005 and 2012 were included in the analysis. Patients underwent PET assessment before and 12 weeks after CRT. Neck dissections were performed for PET-avid residual nodal abnormalities after complete response at the primary site. Rate of isolated nodal failure (INF) was the primary outcome.
  
  
  RESULTS
  Median follow-up from diagnosis for 33 patients was 30 months (range, 6-76 months). INF occurred in 2 patients (6%) with neck dissections performed in 4 cases (12%). First failure was predominantly distant metastatic (10; 30%).
  
  
  CONCLUSIONS
  The rate of INF remains low when following a PET-directed neck management policy after definitive CRT for N3 (>6 cm) HNSCC.
authors.affiliation: Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: Adams
authors.forename: Sandro V
authors.initials: SV
authors.lastname: Porceddu
authors.forename: David I
authors.initials: DI
authors.lastname: Pryor
authors.forename: Benedict
authors.initials: B
authors.lastname: Panizza
authors.forename: Matthew
authors.initials: M
authors.lastname: Foote
authors.forename: Ann
authors.initials: A
authors.lastname: Rowan
authors.forename: Bryan
authors.initials: B
authors.lastname: Burmeister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: N3; head and neck; positron emission tomography (PET); radiotherapy; squamous cell carcinoma