Long-term results of positron emission tomography-directed management of the neck in node-positive head and neck cancer after organ preservation therapy

Summary Objectives The current study presents the long-term results from a study designed to evaluate a restaging positron emission tomography (PET) directed policy whereby neck dissections were omitted in all node positive head and neck squamous cell carcinoma (N + HNSCC) patients with PET-negative lymph nodes after definitive radiotherapy (RT), with or without chemotherapy. Methods A post-therapy nodal response assessment with PET and computed tomography (CT) was performed in patients who achieved a complete response at the primary site after definitive radiotherapy. Patients with PET-negative lymph nodes were observed regardless of residual CT abnormalities. Results One hundred and twelve patients, the majority of whom (83 patients, 74%) had oropharyngeal primaries, were treated on protocol. Median follow-up was 62 months. Negative and positive predictive values for the restaging PET was 97.1% and 77.8% respectively, with only one patient who was PET-negative after treatment experiencing an isolated nodal relapse. Conclusion PET-guided management of the neck following organ preservation therapy effectively spares neck dissections in patients with N + HNSCC without compromising isolated nodal control or overall survival.