title: Risk stratification of metastatic neck nodes by CT and PET in patients with head and neck cancer receiving definitive radiotherapy.
abstract: The aim of this study was to investigate the prognostic impact of CT and (18)F-FDG PET/CT on the outcome of metastatic neck node (MNN) in patients with head and neck cancer receiving definitive radiotherapy or chemoradiotherapy.
  
  
  METHODS
  This patient-based study included 91 patients diagnosed with pharyngeal cancers with MNN (N1, 15; N2, 70; N3, 6). All had pretreatment CT and PET/CT before definitive chemoradiotherapy/radiotherapy. Parameters of MNNs for each patient, including maximal diameter, nodal volume, radiologic central necrosis, maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG), were retrieved for the analysis. Nodal relapse-free survival (NRFS) and survivals were calculated using the Kaplan-Meier method. Independent predictors were identified using Cox regression analysis.
  
  
  RESULTS
  After a median follow-up of 18 mo, 64 patients remained nodal relapse-free, and 27 experienced neck recurrence. Multivariate analysis showed that the application of 40% of the maximal uptake of nodal TLG (N-TLG40%) 38 g or greater (P = 0.03; hazard ratio, 2.63; 95% confidence interval, 1.10-6.30) and radiologic necrosis on CT scan (P = 0.001; hazard ratio, 10.99; 95% confidence interval, 2.56-47.62) were 2 adverse features for NRFS. Patients who had an N-TLG40% 38 g or greater and central radiologic necrosis had a significantly inferior 2-y NRFS (53% vs. 77% and 45% vs. 95%, respectively).
  
  
  CONCLUSIONS
  The outcome of MNNs in patients with head and neck cancer receiving chemoradiotherapy/radiotherapy can be predicted according to radiologic necrosis and N-TLG40% value. The 2 adverse features should be validated in future trials. In this way, patients can be treated alternatively or aggressively.
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan School of Medicine, China Medical University, Taichung, Taiwan School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Shang-Wen
authors.initials: SW
authors.lastname: Chen
authors.affiliation: Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; and Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsieh
authors.affiliation: Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; and Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Yen
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.
authors.forename: Shih-Neng
authors.initials: SN
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yao-Ching
authors.initials: YC
authors.lastname: Wang
authors.affiliation: School of Medicine, China Medical University, Taichung, Taiwan Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; and d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004358:Drug Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000627:therapeutic use; D006019:Glycolysis; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009336:Necrosis; D009364:Neoplasm Recurrence, Local; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; CT; head and neck cancer; metastatic neck lymph node; radiotherapy