PET-CT surveillance versus neck dissection in advanced head and neck cancer
| Autor: | Hisham, Mehanna, Wai-Lup, Wong, Christopher C, McConkey, Joy K, Rahman, Max, Robinson, Andrew G J, Hartley, Christopher, Nutting, Ned, Powell, Hoda, Al-Booz, Martin, Robinson, Elizabeth, Junor, Mohammed, Rizwanullah, Sandra V, von Zeidler, Hulya, Wieshmann, Claire, Hulme, Alison F, Smith, Peter, Hall, Janet, Dunn, Ashoke, Biswas |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Kaplan-Meier Estimate 030218 nuclear medicine & medical imaging RC0254 03 medical and health sciences 0302 clinical medicine medicine Humans Prospective Studies Stage (cooking) Prospective cohort study Survival rate Neoplasm Staging business.industry Hazard ratio Head and neck cancer Neck dissection General Medicine Chemoradiotherapy Middle Aged medicine.disease R1 Surgery Intention to Treat Analysis Survival Rate Dissection Head and Neck Neoplasms 030220 oncology & carcinogenesis Lymphatic Metastasis Positron-Emission Tomography Carcinoma Squamous Cell Quality of Life Neck Dissection Female Neoplasm Recurrence Local business Tomography X-Ray Computed Follow-Up Studies |
| Zdroj: | Mehanna, H, Lup Wong, W, McConkey, C C, Rahman, J K, Robinson, M, Hartley, A G J, Nutting, C, Powell, N, Al-Booz, H, Robinson, M, Junor, E, Rizwanullah, M, Von Zeidler, S V, Wieshmann, H, Hulme, C, Smith, A F & Hall, P & Dunn, J 2016, ' PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer ', New England Journal of Medicine, vol. 374, no. 15, pp. 1444-1454 . https://doi.org/10.1056/NEJMoa1514493 |
| ISSN: | 1533-4406 0028-4793 |
| Popis: | Background\ud \ud The role of image-guided surveillance as compared with planned neck dissection in the treatment of patients with squamous-cell carcinoma of the head and neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate.\ud \ud Methods\ud \ud In this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography–computed tomography (PET-CT)–guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with neck dissection performed only if PET-CT showed an incomplete or equivocal response) to planned neck dissection in patients with stage N2 or N3 disease. The primary end point was overall survival.\ud \ud Results\ud \ud From 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the patients had oropharyngeal cancer, and 75% had tumor specimens that stained positive for the p16 protein, an indicator that human papillomavirus had a role in the causation of the cancer. The median follow-up was 36 months. PET-CT–guided surveillance resulted in fewer neck dissections than did planned dissection surgery (54 vs. 221); rates of surgical complications were similar in the two groups (42% and 38%, respectively). The 2-year overall survival rate was 84.9% (95% confidence interval [CI], 80.7 to 89.1) in the surveillance group and 81.5% (95% CI, 76.9 to 86.3) in the planned-surgery group. The hazard ratio for death slightly favored PET-CT–guided surveillance and indicated noninferiority (upper boundary of the 95% CI for the hazard ratio |
| Databáze: | OpenAIRE |
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