Title: Computed Tomography for Staging in Head and Neck and Oral Cancer
How accurate are we? Are we underestimating our clinical target volume?
Authors: Dr Bindhu Joseph, Dr Kurian J Puthur, Dr Rekha V Kumar, Dr Champaka G, Dr V Lokesh, Dr Ashok Shenoy, Dr Sabitha K. S., Dr Ramesh C
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.107
Abstract
Aim: To compare radiological [Computed Tomography (CT)] tumour and nodal dimensions in head and neck and oral cancer with post-operative pathological status and explore the ramifications associated with disparity.
Materials and Methods: This prospective analytical study was conducted on a cohort of 90 patients with operable oral and head and neck cancer. Forty patients with head and neck cancer and 50 oral cancer patients were radiologically evaluated pre-operatively and assigned a clinical tumour, node and metastasis (TNM) staging, which was subsequently compared with the corresponding pathological TNM components.
Results: A significant comparative disparity was seen in 38 [42%] patients with relation to T category. Pathologically larger tumour dimensions were evidenced in both categories. Sixteen oral cancer patients and 16 patients with head and neck cancer had greater than 30% increase in tumour dimensions in the post-operative pathological staging. This did achieve statistical significance [p= 0.00]. The specificity of CT scan in defining low-risk nodal volumes [cNo Neck] was 76% for oral cancers and 53.8% in head and neck cancer subjects. The rate of false positives for both categories was fairly high, i.e., 48% and 37.9%, respectively.
Conclusion: By theoretically extrapolating the inferences of this study to situations where radiotherapy would be the primary treatment, our findingswould draw caution towards considering overtly conservative/uniform clinical tumour dimensions and estimating intermediate nodal target volumes at risk solely on the basis of CT-based evaluation.
Keywords: Advanced Head and Neck cancer, Computed tomography, Clinical target volumes, IMRT, TNM.
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