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Case study: PET-Neck - Impact Case Study

This study compared PET-CT guided active surveillance with planned neck dissection for locally advanced nodal metastases in patients with head and neck squamous cell cancer treated with primary radical chemoradiotherapy.

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PET-Neck

Many cancers require surgery as part of their treatment pathway to reduce or remove a tumour. This can result in longer recovery, an increase in hospital visits, and other long-term effects that will impact on the patient.

The PET-Neck study aimed to reduce the amount of surgery required for patients with head and neck cancer by using novel imaging called PET-CT-guided  surveillance imaging. This is a scan used to produce detailed images of the inside of the body, compared with planned neck surgery in patients with head and neck cancer.

PET-Neck evaluated the efficacy and cost effectiveness of PET-CT–guided surveillance, which is a scan used to show active cancer cells inside of the body, compared with planned neck surgery in patients with head and neck cancer.

The study involved selecting patients who require surgical intervention based on latest imaging technology, and sparing patients invasive procedures that will not benefit them. In trials such as PET-Neck, it is evident that surgeons embedded in multidisciplinary trials are crucial to increasing the output of high level evidence in the NHS.

Key features

  • Led by Prof Hisham Mehanna
  • Study opened on 02/10/2007 and closed on 13/09/2012
  • Phase III, Randomised controlled
  • 564 patients recruited
  • 43 NHS Trusts involved in recruitment
  • Funded by the NIHR Evaluation, Trials and Studies Coordinating Centre

Findings

Planned neck dissection was often performed before or after patients with head and neck cancer undergo chemoradiotherapy.

Using PET-CT to detect persistent disease decreased the number of neck dissections needed by 80% and possibly lead to improved patient outcomes.

The PET-Neck study showed that not only did the use of PET-CT imaging avoid unnecessary surgery, but that it offers a per-person cost saving to the NHS.

The 2-year overall survival rate was 84.9% (95% confidence interval [CI], 80.7 to 89.1) in the surveillance group and 81.5% (95% CI, 76.9 to 86.3) in the planned-surgery group.

The use of innovative imaging techniques in head and neck cancer studies is a positive step forward for cancer research.

“Planned neck dissection was often performed before or after patients with head and neck cancer undergo chemoradiotherapy. Using PET-CT to detect persistent disease decreased the number of neck dissections needed by 80% and possibly lead to improved patient outcomes.”

Prof Hisham Mehanna, PET-NECK Study Chief Investigator

Value to the NHS

  • The use of PET-CT imaging avoids head and neck cancer patients having to undergo and unnecessary surgery.
  • The PET-Neck study findings offer a substantial saving to the NHS, with a per-person cost saving of over £1,400 over two years.
  • As a result of the study, PET-CT guided surveillance has now become the standard of care in the NHS.

Key publications