Improving imaging diagnosis of persistent nodal metastases after definitive therapy for oropharyngeal carcinoma: specific signs for CT and best performance of combined criteria

BACKGROUND AND PURPOSE

Criteria for detection of persistent nodal metastases in treated oropharyngeal tumors are sensitive but nonspecific, leading to unnecessary nodal dissections. Developing specific imaging criteria for persistent nodal metastases could improve diagnosis while decreasing patient morbidity.

MATERIALS AND METHODS

Patients with oropharyngeal squamous cell carcinoma with nodal metastases treated by definitive radiation therapy and subsequent nodal dissection were retrospectively evaluated. One hundred thirty-eight patients had pre- and posttherapy contrast-enhanced CTs evaluated by radiologists blinded to the status of pathologically proved hemineck persistent nodal metastases. Composite scoring criteria for CT, combined from individual parameters, were compared with radiologists' opinions, previous multiparameter criteria, and outcome data.

RESULTS

New low-attenuation areas and a lack of size change (<20% cross sectional area) were both highly specific for persistent nodal metastases (99%; P = .0004). Extranodal disease on pretherapy imaging was moderately specific (86%; P = .001). The CSC correctly placed 29 patients in a low-risk category compared with 14 by previously reported criteria and radiologist reports. With good second-rater reliability, the CSC cutoff values stratified patients at highest risk of persistent nodal metastases, thereby improving specificity while maintaining sensitivity.

CONCLUSIONS

Comparing pre- and posttherapy examinations improves specificity by discriminating focal findings and size change compared with a single time point. The CSC can categorize the risk of persistent nodal metastases more accurately than previous CT methods. This finding has the potential to improve resource use and reduce surgical morbidity.

New aspects of induction chemotherapy for head and neck cancer: POSTASCO 2011

Treatment options of patients with advanced head and neck cancer developed in the last years. Surgical approaches with or without radiotherapy used to be the standard therapy for a long time. Calls for organ preservation, poor overall survival and unsatisfactory quality of life made changes in this therapy regime necessary. Systemical approaches were evaluated, first concepts of platinum-based chemotherapy paired with 5-fluorouracil (PF) made up the basis of induction chemotherapy (ICT). Hypothesized advantage of this regime was improvement in local and distant tumor responsiveness with an acceptable toxicity profile. Further investigations proved the addition of docetaxel (TPF) superior to PF, which presents the gold standard of current induction chemotherapy regimes. Long-term results underlining well-known aspects of this regime as well as new approaches of induction chemotherapy were published at ASCO 2011, including the addition of bioimmunotherapy to radiotherapy, adding nanoparticle-bound albumin to chemotherapy and investigations in toxicity reduction. Further investigations are still made not only to increase survival outcomes and local control but also to improve quality of life by reducing acute and late toxicities.