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Residual nodal disease, high metabolic tumor volume associated with distant metastases in SCCHN
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Residual nodal disease after platinum-based concurrent chemoradiation and high pretreatment metabolic nodal volume predicted increased risk for distant metastases in patients with node-positive head and neck cancers. Patients with high metabolic nodal volume, however, seemed more likely to have a complete pathologic nodal response.
Although detection and treatment advances have shown good locoregional control in node-positive head and neck squamous cell cancer, predictive criteria for distant metastases remain unclear. Therefore, researchers conducted a study in which they analyzed data from 102 patients with node-positive squamous cell cancer treated with concurrent chemoradiation. The median follow-up was 29 months.
Kenneth S. Hu, MD, associate professor of clinical radiation oncology at Beth Israel Medical Center in New York, presented the findings.
Among the 117 dissected necks, 29% had residual nodal disease. Residual nodal disease was related to N category as follows: 17% of patients with N1/2a disease, 28% for N2b, 31% for N2c and 45% for N3. The main pattern of failure in patients with residual nodal disease was distant metastases with a three-year rate of 35% vs. 13% in those with pathologic complete response (P<.05). The three-year locoregional failure rate was also higher in those with residual nodal disease than in those with node-negative disease (18% vs. 3%; P<.05).
Among 46 patients staged with PET/CT, the median value for metabolic nodal volume was 71, and the maximum SUV ranged from 2 to 36.6. Patients with high metabolic nodal volume were at lower risk for residual nodal disease (17%) than those with metabolic nodal volume below the median (43%; P=.045).
The two-year risk for distant metastases, however, was greater for those with high metabolic nodal volume values (32%) vs. those with low values (15%; P=.09). The lowest rates of distant metastasis were observed in those with low metabolic nodal volume and in those with node-negative disease.
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- Hu K. #12.