Department of Medical Imaging, University of Toronto, Canada.
Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada.
Radiother Oncol. 2021 Apr;157:255-262. doi: 10.1016/j.radonc.2021.02.005. Epub 2021 Feb 16.
To describe the utilization pattern of head and neck (HN) surveillance imaging and explore the optimal strategy for radiologic "residual" lymph node (LN) surveillance following definitive (chemo)radiotherapy (RT/CRT) in human papillomavirus (HPV)+ oropharyngeal carcinoma (OPC).
All HPV+ OPC patients who completed RT/CRT from 2012 to 2015 were included. Schedule and rationale for post-treatment HN-CT/MRI were recorded. Imaging findings and oncologic outcomes were evaluated.
A total of 1036 scans in 412 patients were reviewed: 414 scans for first post-treatment response assessment and 622 scans for the following reasons: follow-up of radiologic "residual" LN(s) (293 scans/175 patients); local symptoms (227/146); other (17/16); unknown (85/66). Rate of scans with "unstated" reason varied significantly among clinicians (3-28%, p < 0.001) and none of them yielded any positive imaging findings. First post-treatment scans identified 192 (47%) patients with radiologic "residual" LNs. Neck dissection (ND) was performed in 28 patients: 16 immediately (6/16 positive), 10 after one follow-up scan (2/10 positive), and 2 after 2nd follow-up scan (1/2 positive). Thirty patients had >2 consecutive follow-up scans at 2-3-month intervals, and none showed subsequent imaging progression or regional failure.
Pattern of HN imaging utilization for surveillance varied significantly among clinicians. Imaging surveillance reduces the need for ND. However, routine HN-CT/MR surveillance without clinical symptoms/signs does not demonstrate proven value in identifying locoregional failure or toxicity. Radiologic "residual" LNs without adverse features are common. If two subsequent follow-up scans demonstrate stable/regressing radiologic "residual" LNs, clinical surveillance without further imaging appears to be safe in this population.
描述头颈部（HN）监测成像的利用模式，并探讨人乳头瘤病毒（HPV）+口咽癌（OPC）患者接受根治性（放化疗）后残留淋巴结（LN）放射学监测的最佳策略。
纳入所有于 2012 年至 2015 年期间完成放化疗的 HPV+OPC 患者。记录治疗后 HN-CT/MRI 的检查计划和检查理由。评估影像学发现和肿瘤学结果。
共回顾了 412 例患者的 1036 次扫描：414 次用于首次治疗后反应评估，622 次用于以下原因：随访放射学“残留”LN（293 次/175 例）；局部症状（227/146）；其他（17/16）；原因不明（85/66）。各临床医生检查原因不明的扫描率差异显著（3-28%，p<0.001），且这些检查均未发现阳性影像学发现。首次治疗后扫描发现 192 例（47%）患者存在放射学“残留”LN。对 28 例患者进行了颈部清扫术（ND）：16 例即刻行 ND（16 例中 6 例阳性），10 例在首次随访扫描后行 ND（10 例中 2 例阳性），2 例在第二次随访扫描后行 ND（2 例中 1 例阳性）。30 例患者连续 2 至 3 个月行 2 次以上连续随访扫描，均未发现影像学进展或区域复发。
HN 影像学监测的利用模式在各临床医生间存在显著差异。影像学监测可减少 ND 的需要。然而，无临床症状/体征的常规 HN-CT/MR 监测在识别局部区域复发或毒性方面并未显示出明确的价值。无不良特征的放射学“残留”LN 较为常见。如果随后的两次随访扫描显示稳定/退缩的放射学“残留”LN，那么在该人群中，无需进一步影像学检查的临床监测似乎是安全的。
