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Adv Ther. 2018 Feb;35(2):161-172. doi: 10.1007/s12325-018-0662-8. Epub 2018 Feb 2.

Detection of Distant Metastases in Head and Neck Cancer: Changing Landscape.

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Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Department of Otorhinolaryngology-Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo, Brazil.
Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain.
Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
University of Udine School of Medicine, Udine, Italy.
Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA.
Coordinator of the International Head and Neck Scientific Group, Padua, Italy.


As head and neck squamous cell carcinoma (HNSCC) patients with distant metastases (DM) were generally treated only palliatively, the value of screening for DM was usually limited to attempts to avoid extensive locoregional treatment when DM were present pretreatment. Recently, the concept of treating oligometastases, e.g., by metastatectomy or stereotactic body radiotherapy, has been reintroduced for HNSCC and may cause a change in the treatment paradigm. Although whole body 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) combined with computed tomography (CT; WB-FDG-PET/CT) is still the mainstay diagnostic technique, there is a growing body of evidence supporting implementation of whole body magnetic resonance imaging (WB-MRI) as an important diagnostic technique for screening for DM. Also, FDG-PET/MRI may become a valuable technique for the detection of DM in HNSCC patients. Because the yield of examinations for detection of DM is too low to warrant routine screening of all HNSCC patients, only patients with high risk factors should be selected for intense screening for DM. Clinical and histopathological risk factors are mainly related to the extent of lymph node metastases. Risk for development of DM may also be assessed by molecular characterization of the primary tumor using genomic and proteomic technologies and radiomics. More research is needed to develop a new protocol for screening for DM after introduction of the concept of treating oligometastases in HNSCC.


Distant metastases; Oligometastases; Positron emission tomography; Risk factors; Whole body magnetic resonance imaging


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