title: Residual neck disease management in squamous-cell carcinoma of the head and neck treated with radiotherapy plus cetuximab.
abstract: OBJECTIVE
  Management of residual neck disease (RND) is one of the unsolved points after bio-radiotherapy (BRT) in loco-regional advanced squamous-cell carcinoma of the head and neck (SCCHN). The aims of the study were to characterize the radiological pattern of response by computed tomography (CT) and to assess the role of positron-emission tomography (PET)/CT in this setting for a better decision-making in the indication of neck dissection (ND).
  
  
  METHODS
  We retrospectively reviewed 202 patients consecutively diagnosed with node-positive SCCHN (N1: 24; N2: 152; N3: 26) who had been treated with concomitant radiotherapy and cetuximab with or without previous induction chemotherapy between 2006 and 2013. Radiological evaluation after treatment was assessed by standard criteria using CT and in addition by PET/CT when RND was suspected in cases from 2010.
  
  
  RESULTS
  There were 42 (21 %) patients who achieved complete response of the primary tumor persisting RND by CT. From this group, 24 patients were managed without PET/CT, leading to the performance of ND in 22 (92 %). On the other hand, 18 patients underwent PET/CT and ND was performed in only 6 (33 %). The overall survival was not different between both groups (p = 0.32). After histological examination and follow-up, PET/CT obtained a positive predictive value of 56 % and a negative predictive value of 89 %.
  
  
  CONCLUSIONS
  Radiological response after BRT is similar to that after treatment with chemo-radiotherapy, thereby validating in this scenario the accepted CT criteria to define complete response of the neck. However, when RND is suspected by CT, PET/CT is useful to prevent unnecessary ND.
authors.affiliation: Medical Oncology Department, Institut Català Oncologia, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Hospitalet de Llobregat, Spain. rmontal@iconcologia.net.
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-8455-4232
authors.initials: R
authors.lastname: Montal
authors.affiliation: Medical Oncology Department, Institut Català Oncologia, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Hospitalet de Llobregat, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Oliva
authors.affiliation: Medical Oncology Department, Institut Català Oncologia, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Hospitalet de Llobregat, Spain.|University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Taberna
authors.affiliation: Medical Oncology Department, Instituto Oncológico del Hospital Provincial de Castellón, Castellón de la Plana, Spain.
authors.forename: L
authors.initials: L
authors.lastname: De Avila
authors.affiliation: Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rovira
authors.affiliation: Radiology Department, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cos
authors.affiliation: University of Barcelona, Barcelona, Spain.|Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Mañós
authors.affiliation: Clinical Investigation Unit, Institut Català Oncologia, Hospitalet de Llobregat, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Navarro
authors.affiliation: Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Nogués
authors.affiliation: Radiation Oncology Department, Institut Català Oncologia, Hospitalet de Llobregat, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Lozano
authors.affiliation: PET Unit, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Rodríguez
authors.affiliation: Medical Oncology Department, Institut Català Oncologia, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Hospitalet de Llobregat, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vilajosana
authors.affiliation: Medical Oncology Department, Institut Català Oncologia, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Hospitalet de Llobregat, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Vázquez
authors.affiliation: Medical Oncology Department, Institut Català Oncologia, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Hospitalet de Llobregat, Spain.|University of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Mesia
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D000068818:Cetuximab / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging / Q000379:methods; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000601:surgery; D000072078:Positron Emission Tomography Computed Tomography; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck
chemical_list: D000068818:Cetuximab
keywords: Bio-radiotherapy; Cetuximab; Neck dissection; PET/CT; Residual neck disease; Squamous-cell carcinoma of the head and neck