Journal Article Ahead of print 1 citation
PubMed: 41206395 DOI: 10.1007/s00405-025-09840-9
SPECT/CT-based sentinel node procedure to guide unilateral elective nodal irradiation in patients with head and neck cancer: technical feasibility and sentinel node mapping outcomes.
Eur Arch Otorhinolaryngol
Authors: Abrahim Al-Mamgani, Ellen Zwijnenburg, Luc Karssemakers, Emilia Owers, Jimmie Honing, Anne I J Arens, Maarten L Donswijk, Laura Smit, Arash Navran, Willem M Klop, Wouter V Vogel, Pieter D de Veij Mestdagh, Johannes H A M Kaanders, Willem H Schreuder
Affiliations
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Radiation Oncology, Amsterdam University Medical Center, Location VUmc, Amsterdam, Boelelaan 1118, Amsterdam, 1081 HZ, the Netherlands.
- Cancer Center Amsterdam, Amsterdam, the Netherlands.
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. Department of Radiation Oncology, Amsterdam University Medical Center, Location VUmc, Amsterdam, Boelelaan 1118, Amsterdam, 1081 HZ, the Netherlands.
- Cancer Center Amsterdam, Amsterdam, the Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.
Abstract
PURPOSE
The majority of patients with HNSCC primarily treated with (chemo)radiation receive bilateral elective nodal irradiation(B-ENI). However, this concept has shown to result in a considerable toxicity and deterioration of quality-of-life. We report on the technical feasibility of a SPECT/CT-based sentinel node procedure (SNP) approach to select patients for unilateral ENI (U-ENI).
PATIENTS AND METHODS
The primary tumor of 90 patients with lateralized T1-4N0-3 (N2c excluded) carcinoma of oropharynx, larynx and hypopharynx were injected under local anesthesia with indocyanine green (ICG)- 99mTechnetium(Tc)-nanocolloid, 3-4 h later SPECT/CT was done for lymph drainage mapping (LDM). Patients without contralateral drainage (CLD) received U-ENI and those with CLD received SNP. Patients with negative SN still received U-ENI while those with positive SN received B-ENI.
ENDPOINTS
contralateral regional failure and toxicity.
RESULTS
Of the entire group, 82% had oropharyngeal cancer, 83% T1-2, and 77% Node-positive disease. LDM was successful in all patients. Flexible laryngoscope with working channel was used for the peri-tumoral injection in 53% of patients. Only 6 patients experienced the procedure as uncomfortable/painful. CLD was seen in 41 patients (45.5%), mainly in level II (63.4%). All of them received SNP and only 8 patients had positive SLN (19.5%), 7 of which in level II. These patients received B-ENI and the other 82 patients (91%) U-ENI. There was only one minor surgical complication (postoperative bleeding).
CONCLUSIONS
The SPECT/CT-based SNP to guide U-ENI is feasible, safe and has resulted in significant increase in proportion of patients treated by U-ENI. The results of oncologic outcome and toxicity need to be awaited.
MeSH
Drainage, Single Photon Emission Computed Tomography Computed Tomography, Neoplasms, Tomography, Emission-Computed, Single-Photon, Head And Neck Neoplasms