Results of a prospective study of positron emission tomography-directed management of residual nodal abnormalities in node-positive head and neck cancer after definitive radiotherapy with or without systemic therapy

Head Neck. 2011 Dec;33(12):1675-82. doi: 10.1002/hed.21655. Epub 2011 Jan 14.


Background: The purpose of this study was to present our prospectively evaluated positron emission tomography (PET)-directed policy for managing the neck in node-positive head and neck squamous cell carcinoma (N+HNSCC) after definitive radiotherapy (RT) with or without concurrent systemic therapy.

Methods: One hundred twelve consecutive patients who achieved a complete response at the primary site underwent a 12-week posttherapy nodal response assessment with PET and diagnostic CT. Patients with an equivocal PET underwent a repeat PET 4 to 6 weeks later. Patients with residual CT nodal abnormalities deemed PET-negative were uniformly observed regardless of residual nodal size.

Results: Median follow-up from commencement of RT was 28 months (range, 13-64 months). Residual CT nodal abnormalities were present in 50 patients (45%): 41 PET-negative and 9 PET-positive. All PET-negative residual CT nodal abnormalities were observed without subsequent isolated nodal failure.

Conclusion: PET-directed management of the neck after definitive RT in node-positive HNSCC appropriately spares neck dissections in patients with PET-negative residual CT nodal abnormalities.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / radiotherapy
  • Cisplatin / therapeutic use
  • Female
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / radiotherapy
  • Humans
  • Lymphatic Metastasis / diagnostic imaging
  • Lymphatic Metastasis / radiotherapy
  • Male
  • Middle Aged
  • Neck
  • Pharyngeal Neoplasms / diagnostic imaging
  • Pharyngeal Neoplasms / radiotherapy
  • Positron-Emission Tomography*
  • Radiotherapy, Conformal
  • Squamous Cell Carcinoma of Head and Neck
  • Tomography, X-Ray Computed


  • Antineoplastic Agents
  • Cisplatin