The role of PET CT in the management of advanced nodal head neck cancer post chemoradiotherapy
We would like to thank the authors for their balanced and informative editorial on our PET NECK study (1).
In response to their points on study design, we did not undertake collection and reporting of the data on patients with histological evidence of tumour in the post-chemoradiotherapy neck dissections mainly because there is no way of reliably identifying whether residual disease identified on histology is viable cancer (2). This can result in an over-estimation of the proportion of patients with viable tumour. With no reliable way of differentiating patients with and without viable tumour, the data becomes of little clinical significance.
We agree that a pre-operative CT scan to identify the characteristics of those who do not respond to chemoradiotherapy is an interesting question. However, it was not one that we set out to answer, and hence it was not included. At the time of study inception, there were difficulties in standardising standardised uptake values (SUV) between different systems and centres (3), and therefore would not have been possible to deliver in a multicentre setting.
Sincerely,
Wai Lup Wong, Hisham Mehanna, Janet Dunn
Acknowledgments
Funding: The PET Neck study was funded by the National Cancer Research Institute's NCC - Health Technology Assessment Unit, UK.
Footnote
Provenance and Peer Review: This article was commissioned and reviewed by the Section Editor Gangcai Zhu (Department of Otorhinolaryngology Head and Neck Surgery, The Second Xiangya hospital, Changsha, China).
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2016.10.89). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Mehanna H, Wong WL, McConkey CC, et al. PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer. N Engl J Med 2016;374:1444-54. [Crossref] [PubMed]
- Porceddu SV, Pryor DI, Burmeister E, et al. Results of a prospective study of positron emission tomography-directed management of residual nodal abnormalities in node-positive head and neck cancer after definitive radiotherapy with or without systemic therapy. Head Neck 2011;33:1675-82. [Crossref] [PubMed]
- Boellaard R, O'Doherty MJ, Weber WA, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 2010;37:181-200. [Crossref] [PubMed]
