Prognostic significance of cervical lymph nodes density evaluated by contrasted computer tomography in head and neck squamous cell carcinoma treated with hyperthermia and radiotherapy.

INTRODUCTION

A correlation between node hypodensity assessed by means of computer tomography (CT) and resistance to both chemotherapy and radiation therapy (XRT) in advanced head and neck tumours has been suggested in the literature. The outcome of a retrospective series of 50 patients with head and neck squamous cell carcinoma (SCC) and cervical nodes metastases treated with combined hyperthermia (HT) and definitive XRT was reviewed to investigate if node density confirmed its prognostic value.

MATERIALS AND METHOD

For all patients, a pre-treatment contrasted CT scan performed at the Institution between 1987-1993 was available. The density of the largest node (> 2cm) was compared to that of adjacent nuchal muscles. Nodes with hypodense areas present in more than one third of the total volume were considered necrotic nodes.

RESULTS

The patients were divided in two groups (with and without nodal necrosis), well balanced in terms of potential prognostic factors. No significant difference in overall nodal response rate, local control and survival was found in the two groups of patients.

CONCLUSION

Nodal density assessed by contrasted CT scan in the series did not result in a significant prognostic factor in patients with SCC node metastases treated with HT and XRT. It is suggested that HT could act as a radiosensitizer in the treatment of hypodense (at CT scan) metastatic nodes overcoming the radioresistance of necrotic, presumably hypoxic nodal metastases.