UK Trial Shows Similar Survival With PET-CT Surveillance vs Planned Neck Dissection in Advanced Head and Neck Cancer
In a UK noninferiority trial reported in The New England Journal of Medicine, Mehanna et al found that positron-emission tomography–computed tomography (PET-CT) surveillance was associated with similar survival vs planned neck dissection in patients with stage N2 or N3 squamous cell carcinoma of the head and neck who had received chemoradiotherapy as primary treatment.
Study Details
In the open-label trial, 564 patients were randomized between 2007 and 2012 to undergo PET-CT surveillance (n = 282) or planned neck dissection (n = 282). PET-CT was performed 12 weeks after the end of chemoradiotherapy, with neck dissection performed only if incomplete or equivocal response was observed. The primary endpoint was overall survival.
Among all patients, 17% had nodal stage N2a disease and 61% had stage N2b disease; 84% had oropharyngeal cancer; and 75% had p16-positive tumor specimens.
Overall Survival
Median follow-up was 36 months. Fewer neck dissections were performed in the PET-CT surveillance group (54 vs 221); among those undergoing surgery, rates of surgical complications were similar (42% vs 38%).
Two-year overall survival was 84.9% (95% confidence interval [CI] = 80.7%–89.1%) in the surveillance group vs 81.5% (95% CI = 76.9%–86.3%) in the planned surgery group; the hazard ratio [HR] was 0.92 (95% CI = 0.65–1.32, P = .66), with the noninferiority criterion being met (upper boundary of the HR 95% CI < 1.50, P = .004). Outcome did not differ according to p16 expression status. Quality of life was similar in the two groups. PET-CT surveillance resulted in savings of £1,492 (approximately US $2,190) per patient over the study duration.
The investigators concluded: “Survival was similar among patients who underwent PET-CT–guided surveillance and those who underwent planned neck dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective.”
The study was funded by the National Institute for Health Research Health Technology Assessment Programme and Cancer Research UK.
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