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      Post-treatment imaging of head and neck cancer

      research-article
      Cancer Imaging
      e-MED
      Tumour recurrence, treatment complication, laryngeal necrosis, osteoradionecrosis, chondroradionecrosis, fistula

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          Abstract

          The expected changes on CT or MRI after treatment of a head and neck cancer are described; it is important not to confuse such expected changes with persisting or recurrent tumour, or a treatment complication. Post-treatment CT or MRI is of value when a recurrent tumour is suspected, to confirm the presence of such a lesion and to determine its extent; this is important information for determining the possibility of salvage therapy. More rarely, imaging may be of use in the differentiation between tumour recurrence and a treatment complication. In patients with a high-risk profile for tumour recurrence after treatment, imaging is of value for surveillance of the patient, as an adjunct to clinical follow-up. The baseline study should be obtained about 3 to 4 months after the end of therapy. There is evidence that tumour recurrences can be detect earlier by systematic follow-up imaging.

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          Most cited references25

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          Osteoradionecrosis: a new concept of its pathophysiology.

          R Marx (1983)
          The classic sequence in the pathogenesis of osteoradionecrosis of the jaws has been accepted as radiation, trauma, and infection. This paper challenges this sequence and offers a new one more accurately describing the biochemical and cellular pathology. The clinical data are based on 26 consecutive cases of osteoradionecrosis from which 12 en bloc resection specimens were cultured and stained for microorganisms. Review of the histories and treatments, as well as the microbial assays, indicates that microorganisms play only a contaminant role in osteoradionecrosis and that trauma is only one mechanism of tissue breakdown leading to the condition. The sequence suggested by this study is as follows: (1) radiation, (2) hypoxic-hypocellular-hypovascular tissue, (3) tissue breakdown, and (4) chronic non-healing wound.
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            An imaging-based classification for the cervical nodes designed as an adjunct to recent clinically based nodal classifications.

            Over the past 18 years, numerous classifications have been proposed to distinguish among the diverse nodal levels. Some classifications have used surgical landmarks, others physical assessment criteria. These classifications do not agree precisely and exhibit sufficient variation that competent physicians could arrive at slightly different staging of the patient's nodal disease. In the past 2 decades, computed tomography and magnetic resonance imaging have offered progressively more refined anatomical precision, reproducibility, and visualization of deep, clinically inaccessible structures. Because the majority of patients with head and neck malignancies presently undergo sectional imaging prior to treatment planning, we felt a need to integrate anatomical imaging criteria with the 2 most commonly used nodal classifications: those of the American Joint Committee on Cancer and those of the American Academy of Otolaryngology-Head and Neck Surgery. The imaging-based nodal classification proposed herein has been developed in consultation with surgeons interested in such classifications in the hope that the resultant classification would find ready acceptance by both clinicians and imagers. It is our desire that the best attributes of imaging, combined with those of the physical assessment, can result in a better and more consistently reproducible nodal staging than is possible by either
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              Is routine follow-up useful after combined-modality therapy for advanced head and neck cancer?

              To evaluate the usefulness of routine follow-up in a selected group of patients with head and neck cancer. Retrospective cohort study with follow-up of 5 years for all patients. Three hundred two patients with advanced (stage II or IV) squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx were treated with curative intent with surgery and postoperative radiation therapy between January 1, 1970, and December 31, 1990. Survival after recurrence of the index tumor or the development of a second head and neck primary tumor. Overall actuarial 5-year survival was 56%. Relapse occurred in 119 patients, and salvage therapy was attempted in 49 patients. Only 2 patients survived to 5 years after relapse. In patients with advanced head and neck squamous cell carcinoma, routine follow-up is more important for evaluation of treatment results and emotional support than of benefit in improving patient survival.
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                Author and article information

                Journal
                Cancer Imaging
                CI
                Cancer Imaging
                e-MED
                1740-5025
                1470-7330
                2004
                12 February 2004
                : 4
                : Spec No A
                : S6-S15
                Affiliations
                Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
                Author notes
                Corresponding address: Robert Hermans, Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Tel.: +32-16-343781; fax: +32-16-343765; Email: robert.hermans@ 123456uz.kuleuven.ac.be
                Article
                CI40007 jCI.v4.i3.pgS6 ci040007
                10.1102/1470-7330.2004.0007
                1435341
                18215976
                db46f14a-984d-44b0-915f-00b82343c0de
                Copyright © 2004 International Cancer Imaging Society
                History
                : 18 January 2004
                Categories
                Article

                tumour recurrence,treatment complication,laryngeal necrosis,osteoradionecrosis,chondroradionecrosis,fistula

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