(HealthDay News) — Image-guided surveillance seems beneficial for patients with squamous-cell carcinoma of the head and neck who have advanced nodal disease, according to a study published online March 23 in the New England Journal of Medicine.
Hisham Mehanna, Ph.D., from the University of Birmingham in the United Kingdom, and colleagues examined the noninferiority of positron-emission tomography-computed tomography (PET-CT)-guided surveillance (performed 12 weeks after chemotherapy, with neck dissection performed only in cases of an incomplete or equivocal response on PET-CT) compared to planned neck dissection in patients with advanced nodal disease. Five hundred sixty-four patients with stage N2 or N3 disease (282 in each group) were recruited from 2007 to 2012 from 37 centers in the United Kingdom. Patients were followed for a median of 36 months.
The researchers found that there were fewer neck dissections with PET-CT-guided surveillance than planned dissection surgery (54 versus 221); similar rates of surgical complications were seen in the two groups (42 and 38 percent, respectively). The two-year overall survival rates were 84.9 and 81.5 percent, respectively, in the surveillance and planned surgery groups. The hazard ratio for death favored the PET-CT-guided surveillance group, suggesting noninferiority (upper boundary of the 95 percent confidence interval, <1.50; P = 0.004).
“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,” the authors write.