The Importance of Imaging in Detecting Complications and Disease Recurrences
Interpreting post-treatment imaging in patients with head and neck cancer can be particularly challenging because of tissue changes resulting from surgery, radiation, chemotherapy, and immunotherapies. It is essential for radiologists to understand these changes and be able to identify them on images to distinguish between treatment-related changes and tumor recurrence. “As radiologists, we see what other members of the multidisciplinary team cannot see with direct visual inspection. Our role in the post-treatment setting is to distinguish expected findings from unexpected complications and detect recurrence early,” said Alok A. Bhatt, MD, professor of radiology at the Mayo Clinic in Jacksonville, FL, and senior author of an article in Radiology: Imaging Cancer on this topic. The article highlighted common findings on post-treatment imaging and some less familiar entities, such as enlarged upper cervical lymph nodes, inflamed thyroglossal cysts, and immunotherapy-related adverse events, that should not be confused with disease recurrence. “It is important to share this knowledge with radiologists, allowing us to guide healthcare teams and assist in patient care,” said Dr. Bhatt.
Identifying Unexpected Complications and Early Recurrences
Head and neck cancer accounts for 3% to 5% of all cancer cases in the United States, and originates from the lips, oral cavity, pharynx, larynx, nasal cavity and paranasal sinuses, salivary glands, and soft tissue. “Different treatment modalities can affect the head and neck in different ways,” Dr. Bhatt explained. “Knowledge of imaging findings after various treatment modalities can help distinguish post-treatment changes from complications and recurrence.” After treatment, patients may experience a variety of expected changes, including mucositis, soft tissue inflammation, laryngeal edema, and salivary gland inflammation. Imaging techniques such as CT, MRI, and PET scans are essential to differentiate these changes from tumor recurrence. Dr. Bhatt and his team recommend a contrast-enhanced neck CT and PET scan to establish a baseline 12 weeks after completing treatment for head and neck cancer. “The goals of surveillance imaging are to distinguish expected findings from unexpected complications and to detect recurrences early,” said Dr. Bhatt. Dr. Bhatt’s team also highlighted treatment-related complications that can occur, including osteoradionecrosis, chondroradionecrosis, carotid artery tears, fistulas, and discitis/osteomyelitis. Many of these complications can be identified early on imaging and can be life-threatening if left untreated. Chondroradionecrosis, for example, can result in airway compromise. “Imaging of head and neck cancer patients can make a real difference. We are often the first to recognize complications such as impending carotid artery tears or chondroradionecrosis,” concluded Dr. Bhatt. “This demonstrates how valuable and integral our role is in the multidisciplinary team.” For more information, visit RSNA. This is an adaptation of original content published by the Radiological Society of America (RSNA).
