PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer

Among patients who received chemotherapy for advanced head and neck cancer, 2-year overall survival was 81.5% in the group assigned to immediate radical neck dissection and 84.9% in the group assigned to positron-emission tomographic–computed tomographic surveillance. Chemoradiotherapy has become a mainstay of primary treatment in patients with squamous-cell carcinoma of the head and neck. However, there are wide variations in the management of advanced nodal disease (stage N2 or N3) in these patients because of the lack of prospective, randomized, controlled trials. 1 , 2 Retrospective studies showed persistent disease on histopathological examination of nodes in up to 40% of patients who underwent neck dissection after chemoradiotherapy 3 and some evidence of a significant survival advantage associated with planned neck dissection. 4 , 5 However, owing to improvements in cross-sectional imaging, consistently low rates of recurrence (