Image-guided surveillance reduces unnecessary surgeries for head and neck cancer

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Utilization of PET-CT imaging surveillance following chemotherapy treatment for squamous-cell carcinoma of the head and neck can help identify patients requiring further treatment such as neck dissection while also reducing unnecessary surgeries, according to results of a study published online March 24 by the New England Journal of Medicine.

With up to 40 percent of patients with head and neck cancer found to have persistent disease following completion of chemotherapy treatment, current guidelines recommend that all such patients undergo planned neck dissection to identify and remove remaining cancer cells.

But the clinical risks of the invasive three-hour surgery have many searching for a better way to manage care through advanced imaging techniques, said lead author Hisham Mehanna, PhD, of the University of Birmingham in Birmingham, Ala., and colleagues.

“Combined morphologic and functional imaging with the use of [PET-CT] can identify both structural and metabolic abnormalities in tumors,” they wrote. “Stratification of patients for neck dissection with the use of PET-CT after chemoradiotherapy may therefore result in fewer neck dissections and a reduced incidence of complications.”

Mehanna and his team set out to compare the performance of planned neck dissection with PET-CT imaging-guided surveillance in the outcomes of patients with head and neck cancer.

To do so they, they conducted a study on 564 patients with stage N2 or N3 of the disease—282 of whom were scheduled to undergo planned neck dissection, and 282 who received PET-CT imaging surveillance 12 weeks after the conclusion of chemotherapy, with neck dissection performed only if scans showed an incomplete or equivocal response to the treatment. They then monitored and compared overall survival outcomes of both groups of study participants.

Their results showed that PET-CT–guided surveillance resulted in dramatically fewer eventual neck dissections than planned dissection surgery (54 and 221, respectively), as well as slightly increased patient survival, with an 85 percent two-year survival rate for those receiving PET-CT surveillance compared to 82 percent for the planned-surgery group. Additionally, image–guided surveillance provided a financial savings of approximately $2,190 per patient over the course of the study time-frame

“Patients in the surveillance group were not disadvantaged by undergoing delayed neck dissection,” the authors concluded. “Survival was similar among patients who underwent PET-CT–guided surveillance and those who underwent planned neck dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective.”