Surveillance using positron emission tomography-computed tomography (PET-CT) scans can be a cost-effective and safe alternative to invasive neck dissection for certain patients with head and neck cancer (HNC), according to a recent study.
Treatment for HNC most often begins with chemotherapy, which has been shown to be effective for managing symptoms and disease progression. After chemotherapy, guidelines suggest that patients with HNC undergo neck dissection surgery to identify any remaining cancer cells. This 3-hour operation is associated with significant morbidity and requires a hospital stay of up to 1 week.
Researchers led by Hisham Mehanna, PhD, University of Birmingham (United Kingdom), performed a prospective, randomized, controlled trial to evaluate the role of PET-CT–guided surveillance versus planned neck dissection surgery in patients with squamous-cell HNC. A total of 564 patients were recruited for the study and were assigned to receive image-guided surveillance or neck dissection. Patients were followed for up to 5 years, with a median follow-up time of 36 months.
In contrast with 221 patients (78%) in the planned dissection group, only 54 patients (19%) undergoing image-guided surveillance group went on to receive neck dissection surgery. Survival outcomes were similar for patients in both groups. A total of 122 patients died during the trail (60 in the surveillance group and 62 in the planned surgery group), and the 2-year survival rates of patients in the surveillance group and in the planned-surgery group were 84.9% and 81.5%, respectively. The hazard ratio for death with surveillance as compared with planned surgery was 0.92, meeting the study’s criteria for non-inferiority. Rates of surgical complications after neck dissection and quality of life scores were also similar between the two groups.
Cost-effectiveness analysis revealed that, over the 2-year minimum follow-up period, PET-CT-guided surveillance was significantly more cost-effective than planned surgery, providing per-patient savings of more than $2,000.
The authors concluded that PET-CT surveillance was both a non-inferior and more cost-effective alternative to planned neck dissection surgery for identifying remaining cancer cells in patients with HNC after chemotherapy treatment. They suggested that more research be done to investigate the role of other imaging methods as well.
