Three months after definitive chemoradiotherapy for node-positive oropharyngeal cancer, a patient has a residual but smaller neck mass. What is the best assessment strategy?
Post-treatment anatomical masses may represent fibrosis. PET-CT at an appropriate interval helps identify metabolically persistent disease and can avoid unnecessary neck dissection when response is complete.
A. Response assessment with appropriately timed PET-CT and MDT interpretation: Post-treatment anatomical masses may represent fibrosis. PET-CT at an appropriate interval helps identify metabolically persistent disease and can avoid unnecessary neck dissection when response is complete.
B. Immediate radical neck dissection for every residual lump: Anatomical persistence alone is not proof of viable tumour.
C. Open biopsy before imaging: This can complicate a treated neck and should not precede planned response assessment.
D. Discharge because the mass is smaller: Residual or recurrent disease must be assessed.
E. Repeat radiotherapy empirically: Re-irradiation without evidence carries major toxicity.
If PET-CT showed focal persistent avidity with corroborating findings, tissue confirmation and salvage planning would be considered.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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