Prognostic significance of cervical lymph nodes density evaluated by contrasted computer tomography in head and neck squamous cell carcinoma treated with hyperthermia and radiotherapy

Introduction: A correlation between node hypodensity assessed by means of c omputer tomography (CT) and resistance to both chemotherapy and radiation t herapy (XRT) in advanced head and neck tumours has been suggested in the li terature. The outcome of a retrospective series of 50 patients with head an d neck squamous cell carcinoma (SCC) and cervical nodes metastases treated with combined hyperthermia (HT) and definitive XRT was reviewed to investig ate if node density confirmed its prognostic value. Materials and method: For all patients, a pre-treatment contrasted CT scan performed at the Institution between 1987-1993 was available. The density o f the largest node (> 2 cm) was compared to that of adjacent nuchal muscles . Nodes with hypodense areas present in more than one third of the total vo lume were considered necrotic nodes. Results: The patients were divided in two groups (with and without nodal ne crosis), well balanced in terms of potential prognostic factors. No signifi cant difference in overall nodal response rate, local control and survival was found in the two groups of patients. Conclusion: Nodal density assessed by contrasted CT scan in the series did not result in a significant prognostic factor in patients with SCC node met astases treated with HT and XRT. It is suggested that HT could act as a rad iosensitizer in the treatment of hypodense (at CT scan) metastatic nodes ov ercoming the radioresistance of necrotic, presumably hypoxic nodal metastas es.