Posttreatment image-guided surveillance achieved similar survival rates as planned neck dissection in patients with head and neck. Innovative scanning-led surveillance may aid in identifying which patients will need neck dissection to removed any remaining cancer cells and also guides neck dissection.1
Guidelines recommended neck dissection for all patients with head and neck cancer, despite the procedure being a 3-hour operation with considerable morbidity and a hospital stay of up to 1 week. Previously, no other method reliably identified which patients still had cancer cells remaining.
This study included a total of 564 patients; 282 in the planned-surgery group and 282 in the surveillance group. Image-guided surveillance used positron emission tomography-computed tomography (PET-CT).
“After treatment, remaining cancer cells play something akin to ‘hide and seek’. Our study shows that using this PET-CT scan we can hunt them down, find them, and remove them effectively,” said Hisham Mehanna, PhD, from the Institute of Head and Neck Studies and Education (InHANSE) at the University of Birmingham in the United Kingdom, and first author of the study.
Only 54 patients (19%) in the image-guided surveillance group went on to undergo neck dissection, compared with 221 (78%) in the control group.
The 2-year overall survival rate was 84.9% in the surveillance group and 81.5% in the planned-surgery group. Both groups had similar quality of life.
“Patient outcomes, and avoiding unnecessary surgery, are the main goals of this study. But there is a cost saving to be made too,” said Mehanna. The study calculated that PET-CT-guided surveillance saved approximately $2190 per person compared with neck dissection over the duration of the trial.
1. Mehanna H, Wong WL, McConkey CC, et al. PET-CT surveillance versus neck dissection in advanced head and neck cancer [published online ahead of print March 23, 2016]. New Engl J Med. doi:10.1056/NEJMoa1514493.