Jackson Hamilton
With human papillomavirus infection reaching epidemic proportions, oropharyngeal cancers are expected to increase in a younger population than that historically afflicted with head and neck cancer. Because these tumors are most often treated nonsurgically, there is always a debate as to whether nodal dissection for posttreatment residual disease is necessary. Ideally, improvements in the specificity of imaging biomarkers would enable us to avoid unnecessary surgery in node-negative patients. By using previously characterized, as well as newly identified, parameters to create the “NE2Ck REaD” criteria, we were able to retrospectively improve diagnostic accuracy in a large cohort.
Several parameters stand out as being novel. When assessing treatment response, rather than initial staging, the change in nodal size is more important than the absolute size. Furthermore, it has been held that nodal calcification is a sign of treatment response; however, our work has shown that partial calcification of a lymph node may be associated with a partial response. In contrast, new necrosis was found to be very specific for residual disease.
These criteria need to be further validated at additional centers beyond MD Anderson Cancer Center, in prospective clinical studies. This would be fairly easy to add to the diagnostic imaging already performed in a therapeutic trial of a novel treatment regimen, to see if it helps with interpretation. Also, it could be correlated to the exact nodes dissected. This article was discussed in the October 2013 AJNR Fellows’ Journal Club podcast by Oregon Health and Science University. It would be very interesting to know their experience since then.