SPECT/CT-guided elective nodal irradiation for head and neck cancer

Abstract

Head and neck squamous cell carcinoma (HNSCC) is often treated with (chemo)radiotherapy. Elective nodal irradiation (ENI) to both sides of the neck is standard in most clinical scenarios, even when patients have lateralized tumors. This causes significant toxicity. In this thesis, lymph drainage mapping using SPECT/CT is investigated as a selection tool for unilateral or limited bilateral ENI. Its feasibility, oncologic safety and favorable toxicity profile are demonstrated. Furthermore, the rate of contralateral nodal failure after bilateral ENI and potential risk factors are investigated. Finally, a follow-up trial is proposed (SUSPECT-2).