Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over

Assessing the evidence

The PET-NECK study is a National Institute for Health Research (NIHR) funded trial that is relevant to NICE's guideline on upper aerodigestive cancer. The aim of this trial is to determine the efficacy and cost-effectiveness of PET-CT guided surveillance compared to planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer. This trial was raised by stakeholders during consultation for the guideline, subsequently added to the NICE surveillance programme trial tracker and results considered in detail when they became available.

The results of the PET-NECK study have been described in detail in an NIHR signal but, in summary, suggest non-inferiority for a less invasive approach (PET-CT scanning compared with planned surgery) with potential cost savings. The guideline on upper aerodigestive cancer does not currently consider the use of PET-CT scan to track progression of cancer before surgery. Furthermore, the PET-NECK study is relevant to one of the research recommendations in the guideline which aims to address the optimal method, frequency and duration of follow-up for people who are disease-free after treatment for cancer of the upper aerodigestive tract. Therefore, it would be pertinent to consider the results of the PET-NECK study in an update of the guideline, particularly in relation to treatment of advanced disease.

The results of the PET-NECK study were discussed with topic experts who agreed that this new evidence is practice changing, could impact on the guideline recommendations and felt that an update was warranted. Topic experts also noted although the results in the patients with N3 disease were similar to the N2 patients, the extrapolation of a PET-CT–guided surveillance policy to this higher-risk group of patients cannot currently be justified because of the small number of such patients in the trial. This will need to be considered as part of the update.

Other clinical areas

This exceptional surveillance review did not search for new evidence relating to other clinical areas in the guideline.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the evidence and views of topic experts and stakeholders, we decided that a partial update is necessary for this guideline.

See how we made the decision for further information.