Twelve weeks after chemoradiotherapy for oropharyngeal cancer, PET-CT shows low-grade residual uptake in one neck node but no progressive mass. The patient is clinically well. What is the best next principle?
Post-treatment inflammation can create equivocal uptake. Decisions integrate imaging pattern, timing, examination and a planned reassessment strategy rather than treating every residual signal as persistent cancer.
A. Perform radical neck dissection immediately: This risks unnecessary morbidity when metabolic findings are equivocal.
B. Discharge permanently because primary treatment is complete: Surveillance remains necessary.
C. Review in the specialist MDT and use response-adapted surveillance rather than automatic neck dissection: Post-treatment inflammation can create equivocal uptake. Decisions integrate imaging pattern, timing, examination and a planned reassessment strategy rather than treating every residual signal as persistent cancer.
D. Repeat PET-CT the next day: Short-interval repetition is unlikely to clarify inflammatory change.
E. Assume all uptake is recurrence: Interpretation must consider post-treatment timing and pattern.
If there were progressive uptake, enlarging nodal disease or clinical suspicion, salvage investigation and treatment would be escalated.
Draft Clinora educational material only; not official JCIE content or clinical advice.
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