Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia.
Faculty of Medicine, University of Queensland, St. Lucia, Australia.
Oral Oncol. 2019 Jan;88:153-159. doi: 10.1016/j.oraloncology.2018.11.033. Epub 2018 Dec 5.
To assess the utility of a repeat positron emission tomography/computed tomography (PET/CT) instead of immediate neck dissection (ND) for incomplete nodal response (IR) in Human Papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPC) following chemoradiotherapy/radiotherapy [(chemo)RT].
Patients with non-distant metastatic, node positive (N+) disease treated between Jan/2005 to Jan/2016, achieved complete response at the primary with no distant relapse on a 12-week re-staging PET/CT were evaluated. Patients underwent surveillance after complete nodal response (CR). Patients with IR underwent repeat PET/CT at 16 weeks to direct neck management. Primary endpoints were CR conversion rate and subsequent regional failure following a 16-week PET/CT directed ND. Secondary endpoints were predictive values (PV) of the 12- and 16-week PET/CT for residual nodal disease, predictors for requiring the 16-week PET/CT, 5 year regional, locoregional failure free survival (FFS) and overall survival (OS).
235 patients were evaluated. Median follow up was 56 (range 19-60) months. 41 patients underwent 16-week re-staging PET/CT, 29 (71%) converted to CR. No subsequent regional failures occurred following a 16-week PET/CT directed ND. Positive and negative PV of the 12- and 16-week PET/CT for residual nodal disease was 12% & 98%, and 33% & 97%, respectively. N-category (AJCC/UICC 7th edition) predicted for requiring a 16-week PET/CT on univariate analysis (P-value 0.02). 5 year regional, locoregional FFS and OS was 95.8%, 93.4% and 90.8%, respectively.
For N+ HPV-associated OPC achieving IR on the 12-week re-staging PET/CT following (chemo)RT, a repeat 16-week PET/CT can spare patients from unnecessary surgery.
评估在 HPV 相关口咽鳞状细胞癌（OPC）患者接受放化疗/放疗（chemoRT）后，对于不完全性淋巴结反应（IR），重复正电子发射断层扫描/计算机断层扫描（PET/CT）而非即刻行颈部清扫术（ND）的作用。
本研究纳入了 2005 年 1 月至 2016 年 1 月期间治疗的非远处转移、淋巴结阳性（N+）疾病患者，这些患者在原发灶完全缓解，12 周再分期 PET/CT 无远处复发。患者在完全缓解后接受监测。对于 IR 患者，在行 16 周重复 PET/CT 以指导颈部管理。主要终点为 CR 转化率和随后 16 周 PET/CT 指导的 ND 后区域失败。次要终点为 12 周和 16 周 PET/CT 对残留淋巴结疾病的预测值（PV）、需要进行 16 周 PET/CT 的预测因素、5 年区域、局部区域无失败生存率（FFS）和总生存率（OS）。
共评估了 235 例患者。中位随访时间为 56 个月（范围 19-60 个月）。41 例患者行 16 周再分期 PET/CT，29 例（71%）转化为 CR。16 周 PET/CT 指导的 ND 后无后续区域失败。12 周和 16 周 PET/CT 对残留淋巴结疾病的阳性和阴性 PV 分别为 12%和 98%，33%和 97%。在单因素分析中，N 分期（AJCC/UICC 第 7 版）预测需要行 16 周 PET/CT（P 值为 0.02）。5 年区域、局部区域 FFS 和 OS 分别为 95.8%、93.4%和 90.8%。
对于在放化疗后 12 周再分期 PET/CT 上出现 IR 的 N+ HPV 相关 OPC 患者，重复进行 16 周 PET/CT 可以避免不必要的手术。
