Management of Advanced Head and Neck Cancer

To the Editor: The PET-NECK randomized trial by Mehanna et al. (April 14 issue) 1 compared surveillance guided by positron-emission tomography–computed tomography (PET-CT) with planned neck dissection after chemoradiotherapy in patients with head and neck squamous-cell carcinoma (HNSCC) and stage N2 or N3 nodal metastases. Patients who had a complete metabolic response but residual lymphadenopathy underwent neck dissection. A complete metabolic response on PET-CT in the presence of residual enlarged nodes has a high negative predictive value in oropharyngeal carcinoma associated with human papillomavirus (HPV). 2 Therefore, although these patients would have undergone neck dissection according to the trial protocol, Mehanna et . . .