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Imaging Techniques May Help Predict Response to Head and Neck Cancer Treatment CHICAGO -- November 16, 2009 -- A combination of imaging tests conducted 6 to 8 weeks after patients complete chemoradiotherapy for head and neck cancer may help identify patients who will respond to treatment and those who will require surgical follow-up, according to a report in the November issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals. During the past 2 decades, chemoradiotherapy has become important in helping preserve organs while treating advanced head and neck cancers, according to background information in the article. “These nonsurgical approaches produce an excellent response at the primary tumour site and cervical lymph nodes resulting in high rates of locoregional disease control,” the authors wrote. “Accurate and timely assessment of disease response at the primary tumour site and cervical lymph nodes after chemoradiotherapy is essential to detect residual disease, to direct surgical salvage, and to prevent tumour recurrence.” James P. Malone, MD, Southern Illinois School of Medicine, Springfield, Illinois, and colleagues analysed 31 patients with advanced-stage head and neck cancer who were treated with chemoradiotherapy between 2004 and 2006. All patients underwent combined positron emission tomography and computed tomography (PET-CT) to detect evidence of persistent tumours 6 to 8 weeks after the completion of treatment and then were tracked for a median of 24 months. Assessing the response of the tumour to treatment with PET-CT had a sensitivity of 83%, specificity of 54%, positive predictive value of 31%, and negative predictive value of 92%. In the 21 patients whose disease had spread to surrounding lymph nodes before treatment, sensitivity was 75%; specificity, more than 94%; positive predictive value, more than 75%; and negative predictive value, 94%. For the 10 whose cancer was located in the neck only, specificity was 92% and negative predictive value, more than 92%. “On the basis of this study, PET-CT performed 6 to 8 weeks after the completion of intra-arterial chemoradiotherapy for advanced squamous cell carcinoma of the head and neck is a valuable tool for measuring treatment response and facilitating clinical decision making,” they concluded. “In addition to early prediction of treatment response, PET-CT provides early detection of distant metastases, which permits earlier intervention in patients with distant disease. Further investigations of PET-CT in homogenously treated patient populations with consistent timing of post-treatment scans are necessary to more clearly elucidate the role of this imaging modality in the management of advanced squamous cell carcinoma of the head and neck.” SOURCE: Archives of Otolaryngology-Head & Neck Surgery E-mail this page to a friend or colleague! To print, use this version