Post-Treatment Neck Dissection of Tonsillar and Base of Tongue Squamous Cell Carcinoma in the Era of PET-CT, HPV, and p16

David Landin; Anders Näsman; Sara Jonmarker Jara; Lalle Hammarstedt-Nordenvall; Eva Munck-Wikland; Tina Dalianis; Linda Marklund

doi:10.3390/v14081693

Post-Treatment Neck Dissection of Tonsillar and Base of Tongue Squamous Cell Carcinoma in the Era of PET-CT, HPV, and p16

Viruses. 2022 Jul 30;14(8):1693. doi: 10.3390/v14081693.

Authors

David Landin^{1

2}, Anders Näsman^{3

4}, Sara Jonmarker Jara⁵, Lalle Hammarstedt-Nordenvall^{1

2}, Eva Munck-Wikland^{1

2}, Tina Dalianis³, Linda Marklund^{1

2

6}

Affiliations

¹ Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden.
² Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden.
³ Department of Oncology, Pathology, Karolinska Institute, 17164 Stockholm, Sweden.
⁴ Department of Clinical Pathology, Karolinska University Hospital, 17164 Stockholm, Sweden.
⁵ Department of Neuroradiology, Karolinska University Hospital, 17164 Stockholm, Sweden.
⁶ Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, 75105 Uppsala, Sweden.

Abstract

Human-papillomavirus (HPV)-positive tonsillar and base of tongue carcinomas (TSCC/BOTSCC) are rising in incidence and treatments with radiotherapy, chemoradiotherapy (RT/CRT), and neck dissections (NDs) have several side effects. Therefore, an improved selection of patients needing salvage NDs would be beneficial. We examined the prevalence and localisations of viable tumour cells in neck lymph nodes in patients post-RT/CRT, identified by fluorodeoxyglucose positron-emission tomography with computer-tomography (FDG PET-CT), with a focus on HPV-associated tumours. Patients with 217 TSCC/BOTSCC with tumours assessed for HPV-DNA and p16^INK4a undergoing FDG PET-CT 12 weeks after treatment and/or an ND were included. The FDG PET-CT data were compared with the findings in the pathology report after the ND. In total, 36/217 (17%) patients were selected for an ND due to positive findings in post-treatment FDG PET-CT. Of these, 35/36 were HPV-associated, 10/36 (28%) had viable tumour cells in the pathology reports of the neck specimen, and 8/10 (80%) were consistent with the FDG PET-CT findings, while 2/36 (5%) were missed by FDG PET-CT. We conclude that FDG PET-CT 12 weeks after RT/CRT is useful, but not completely reliable for finding all the metastases of HPV-associated TSCC/BOTSCC. Nonetheless, our data indicate that an ND could be more selectively guided by FDG PET-CT.

Keywords: PET-CT; base of tongue squamous cell carcinoma; human papillomavirus; metastasis; oropharyngeal squamous cell carcinoma; tonsillar squamous cell carcinoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Squamous Cell* / diagnostic imaging
Carcinoma, Squamous Cell* / therapy
Fluorodeoxyglucose F18
Head and Neck Neoplasms*
Humans
Neck Dissection
Papillomaviridae / genetics
Papillomavirus Infections* / complications
Positron Emission Tomography Computed Tomography
Retrospective Studies
Tongue / diagnostic imaging
Tongue / pathology
Tongue Neoplasms* / diagnostic imaging
Tongue Neoplasms* / therapy
Tonsillar Neoplasms* / diagnostic imaging
Tonsillar Neoplasms* / therapy

Substances

Fluorodeoxyglucose F18

Grants and funding

This research was funded by the Swedish Cancer Foundation (grant no. 200705, 200764, and 200778), the Stockholm Cancer Society (grant no. 201092 and 201272), the Swedish Cancer and Allergy Foundation (grant no. 10137), the Stockholm City Council (grant no. 960459), and Karolinska Institutet.