Abstract
In head and neck cancer, the presence of nodal disease is a strong determinant of prognosis and treatment. Despite the use of modern multimodality diagnostic imaging, the prevalence of occult nodal metastases is relatively high. This is why in clinically node negative head and neck cancer the lymphatics are treated “electively” to eradicate subclinical tumor deposits. As a consequence, many true node negative patients undergo surgery or irradiation of the neck and suffer from the associated and unnecessary early and long-term morbidity. Safely tailoring head and neck cancer treatment to individual patients requires a more accurate pre-treatment assessment of nodal status. In this review, we discuss the potential of several innovative diagnostic approaches to guide customized management of the clinically negative neck in head and neck cancer patients.
Highlights
Head and neck squamous cell carcinoma (HNSCC) accounted for 890,000 new cases and 450,000 deaths worldwide in 2018 and overall 5-year survival is 50–60% [1, 2]
Another ongoing study investigates the feasibility of USPIO-enhanced magnetic resonance imaging (MRI) for visualization of tumor spread in lymph node positive HNSCC patients
An international multi-center phase 3 pivotal trial has been initiated to register USPIO-enhanced MRI for the detection of nodal involvement in prostate cancer which can lead to more widespread production and clinical use [53]
Summary
Head and neck squamous cell carcinoma (HNSCC) accounted for 890,000 new cases and 450,000 deaths worldwide in 2018 and overall 5-year survival is 50–60% [1, 2]. With curative radiotherapy it is common practice to deliver a high dose to gross tumor locations and a lower “elective” dose to areas of presumed small tumor deposits These include more distant areas of local tumor extensions, e.g., perineural or spidery growth and draining lymph node stations. The occult nodal metastatic load that needs elective treatment has decreased due to improvements in diagnostic accuracy of the neck with state-ofthe-art imaging [31, 32]. This indicates that nowadays unnecessary large areas with a decreasing tumor volume are being irradiated with a radiation dose that is likely to be higher than required, resulting in unintended dose-escalation or overtreatment. Implications on safety, toxicity and quality of life are evaluated
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