The radiation diagnosis is expected to bear an important role in the evaluation of the chemoradiation therapy (CRT) for head and neck cancers; however, the current ability of radiation diagnosis is not satisfied the demands from clinical doctors. In this article, the author will discuss about the problems of response evaluation criteria in solid tumor (RECIST), which is now becoming to be considered as a global standard when this criteria is indicated for the evaluation of head and neck cancers. The author will also mention about the role of CT and MRI in the management strategy of head and neck cancers in which CRT is indicated, especially, the low effectiveness of contrast enhanced CT after CRT. In the last part of this article, the author will introduce MR spectroscopy and diffusion weighted imaging which are new evaluation modalities of MRI and are expected to be useful for early effect prediction of CRT.

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Thirteen patients with locoregional advanced head and neck squamous cell carcinoma treated by intensive concurrent chemoradiotherapy (CRT) whose primary site were CR but neck were equivocal by CT or MRI underwent FDG-PET 1-12 month after the end of CRT. Seven unresectable cases were included. Results: Thirteen patients with a total of 20 cervical lymphadenopathy were evaluated by FDG-PET (visual analysis). A negative predictive value (NPV) was low with 50% in 1-2 month after CRT but high with 92% in 3-12 month. Conclusion: We suggested that FDG-PET should be performed three months, after CRT and lymphadenopathy (<1cm) on negative PET should be observed, lymphadenopathy (≥1cm) on negative PET should be close monitered or neck dissection should be performed after informed discussion with the patient, and neck dissection be performed if lymphadenopathy is positive on PET.

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The usefulness of ultrasonography for the diagnosis of lymph node metastasis of head and neck squamous cell carcinoma after chemoradiotherapy was examined. The therapeutic effect of the metastatic lymph nodes of the 51 patients with hypopharyngeal cancer was evaluated by ultrasonography (US) before and after concurrent chemoradiotherapy. The patients whose lymph nodes became “disappearance” or “scar”, or had degeneration by treatment showed an excellent prognosis. These changes of lymph nodes could be examined only by US. Evaluation of the therapeutic effects of cervical lymph node metastases using US was revealed to be useful to predict prognosis.

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Objective: To review our experience in the treatment of concurrent chemoradiotherapy (CCRT) for patients with advanced resectable squamous cell carcinoma of the head and neck (SCCHN) and to evaluate the different factors affecting survival and primary organ preservation. Patients and Methods: We reviewed the records of 85 patients with resectable stage III-IV SCCHN treated with CCRT between February 1998 and April 2004. Overall survival (OS), disease-specific survival (DSS), and DSS with primary organ preservation were estimated using Kaplan-Meier methods. The log-rank test and Cox proportional hazards regression were employed to identify significant prognostic factors for survival and primary organ preservation. Results: The 5-year OS and DSS for all patients were 60.6% and 75.1%, respectively. On multivariate analysis, degree of histological differentiation was significant predictor of DSS for patients undergoing CCRT; T stage and differentiation were significant prognostic factors for primary organ preservation. Conclusion: Organ preservation treatment approach using concurrent chemoradiotherapy is the treatment of choice for selected patients with resectable stage III and IV SCCHN. In addition, CCRT may improve survival in patients with poorly differentiated SCCHN. In patients with well differentiated tumor and T3 to T4, improvement of treatment methods was considered to improve survival.

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Patients and methods: 9 and 21 patients with head and neck squamous cell carcinoma using neoadjuvantive chemotherapy and preoperative chemoradiotherapy. These patients were operated at Cancer Institute Hospital of Japanese Foundation for Cancer Research from 2000 to 2007. The efficacies of these preoperative treatments were evaluated by pathological specimens. Results: Clinical evaluations of preoperative treatment were different from pathological evaluations, clinical evaluations must be more accurate. These pathological specimens revealed that 4 patterns of cancer remaining in this study. Conclusion: We can't conclude whether we can reduce the resection area of primary or not after preoperative treatment, but some cases could reduce the resection area. We need to discussed about possibilities of reducing resection area after induction chemotherapy.

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We analyzed salvage surgeries for recurrent laryngeal cancer following chemoradiotherapy. Between 1995 and 2001, all 23 patients with recurrent diseases after completion of chemoradiotherapy using carboplatin or cisplatin underwent total laryngectomy. Between 2002 and 2005, 10 patients underwent salvage surgeries after completion of chemoradiotherapy using docetaxel; total laryngectomy was performed in 6 patients and larynx-preserving surgeries were performed in 4 patients. Close follow-up for a longer period following chemoradiotherapy is recommended because not a few patients had recurrent diseases more than 2 years after completion of the treatment. Most patients who underwent total laryngectomy and insertion of indwelling voice prostheses achieved excellent to moderate speech ability. There was an increased risk of wound complications in patients undergoing salvage surgeries following chemoradiotherapy. Therefore, appropriate wound management for salvage surgeries is an important issue for head and neck surgeons.

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Salvage surgery for recurrent tumors on primary site after chemoradiothrapy was performed on hirty-seven patients between 1998 and 2007. Their primary sites were as follows: larynx 12, oral cavity 2, hypopharynx 7, oropharynx 6, and paranasal sinus 10. We examined postoperative wound problems of these patients. It was found that some postoperative wound problems occurred in about half of them, but no apprehensive serious or fatal complications happened. The reasons of no serious postoperative wound problems were speculated as follows: elective neck dissections were not performed but reconstruction procedures by microvascularized tissue transfer were performed in most patients, and the irradiated fields were smaller in the patients with laryngeal carcinoma. To our knowledge, the skilled plastic surgeon is essential to the success of salvage surgery, who can accomplish the microvascular procedures even in the bad conditions after chemoradiothrapy.

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Background: Chemoradiation for treating advanced head and neck cancer is becoming more widely used. Studies indicate that there is a high rate of local and regional disease control and organ preservation. Methods: All of the 19 patients (16 concurrent chemoradiation, 3 intra-arterial chemoradiation) had planned neck dissection 6-8 weeks after completion of radiation. Conventional external beam irradiation was used to a total dose of 62 to 73 Gy. Selective neck dissection was done whenever possible. Radical and modified radical neck dissection for patients who had residual adenopathy that invaded to surrounded structures and/or enclosed the carotid arteries. Results: Complete response in the primary and regional sites was obtained in 19 of 19 (100%) and 17 of 19 (89.5%), respectively. Of the 19 cases, 5 (26%) had viable cancer cells within their neck dissection specimens. There were 3 recurrences (15.8%): 1 local (5.3%), 1 regional (5.3%), and 1 distant (5.3%). The local and regional disease control was excellent after chemoradiation with planned neck dissection. Conclusions: We believe chemoradiation represents an effective treatment for patients with advanced head and neck cancer and possibly improved survival. Planned neck dissection was recommended for all patients with N2-3 neck nodes regardless of clinical response. Selective and superselective neck dissection spare function and minimize morbidity.

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