Determination of unresectability in head and neck cancer with imaging

Abstract

Head and neck cancer, particularly potentially unresectable advanced lesions, should be accurately evaluated because the results strongly impact on a treatment planning and patient outcomes. Radiologists must carefully detect the presence of deep invasion that may upstage a tumor to stage T4b and predict inoperability in cases of lymph node metastases. The most common and crucial factors associated with unresectability are carotid encasement, prevertebral fascia involvement (primary and Lymph node lesion) and nasopharyngeal extension (primary). CT offers high spatial and temporal resolution, and MR offers high contrast resolution for images. Understanding the advantages, limitations, and appropriate criteria of each imaging modality (CT/MRI) for detecting the factors that determine unresectability improves decision-making regarding treatment, thus ensuring optimal therapeutic outcomes.