title: Lessons from a standardized program using PET-CT to avoid neck dissection after primary radiotherapy for N2 squamous cell carcinoma of the oropharynx.
abstract: OBJECTIVE
  To report the results of a standardized program using positron emission tomography (PET)-computed tomography (CT) approximately 12 weeks after primary radiotherapy to determine the need for a planned neck dissection in patients with radiographic N2 squamous cell carcinoma (SCC) of the oropharynx.
  
  
  METHODS
  Fifty consecutive patients with T1-4 and hemineck radiographic stage N2A-B SCC of the oropharynx for whom the only indication for planned neck dissection was a positive PET-CT performed ∼12 weeks after completing primary treatment with radiotherapy.
  
  
  RESULTS
  Results of PET-CT to identify residual neck disease were as follows: sensitivity and positive predictive value, 0%; specificity, 89%; negative predictive value, 91%; potential neck recurrence from using this 12-week PET-CT program, 2%. The time between negative PET-CT and detection of neck recurrence was 0.5, 0.6, 1.2, and 2.0 years. The rate of successful (>1 year) salvage of neck recurrence was 25% (1/4).
  
  
  CONCLUSIONS
  PET-CT approximately 12 weeks after radiotherapy for oropharyngeal cancer is an excellent way to identify patients who do not need neck dissection. Approximately half of neck recurrences present over 1 year after negative PET-CT and the chance of successful salvage is low.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Hitchcock
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States. Electronic address: amdurr@shands.ufl.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.affiliation: Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL, United States.
authors.forename: John W
authors.initials: JW
authors.lastname: Werning
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville, FL, United States.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Drane
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville, FL, United States.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Mancuso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Neck dissection; Oropharynx; PET; Radiation therapy; Radiochemotherapy