1. ACRIN 6685 Overview ACRIN 6685 A Multi-center Trial of FDG-PET/CT Staging of Head and Neck Cancer and its Impact on the N0 Neck Surgical Treatment in Head and Neck Cancer Patients

2. ACRIN 6685 Overview Protocol Investigators Protocol Investigator Val J. Lowe, M.D. Mayo Clinic Surgical Co-Investigator Brendan C. Stack, Jr., M.D., F.A.C.S. University of Arkansas for Medical Sciences QOL/CEA Co-Investigator Christopher S. Hollenbeak, Ph.D. Depts. of Surgery and Public Health Sciences Study Statistician Fenghai Duan, Ph.D. Center For Statistical Sciences Brown University

3. ACRIN 6685 Overview Protocol Overview  Schema  Aims  Hypotheses  Sample Size  Inclusion and Exclusion Criteria

4. ACRIN 6685 Overview Study Aims Primary Aim Determine the negative predictive value of PET/CT for the N0 neck based upon pathologic sampling of the neck lymph nodes and determine PET/CT’s potential to change treatment of the N0 neck.

5. ACRIN 6685 Overview Study Hypotheses 1.PET/CT can more accurately identify head and neck cancer—or the absence thereof—at primary, nodal, or distant sites than clinical exam, CT, or MRI. 2.The additional PET/CT imaging information will lead to important changes in patient care, patient QoL, costs, and cost- effectiveness, specifically as relate to treatment of the N0 neck. These changes may result from:  upstaging an N0 neck to N+,  better defining extent of primary disease, or  uncovering unappreciated distant metastasis.

6. ACRIN 6685 Overview Study Hypotheses 3.Other biomarkers may correspond to FDG-PET/CT findings, clinical stage, and patient outcomes. These findings may reflect the aggressiveness of the clinical course, which in turn may direct the patient towards more or less aggressive modality therapy.

7. ACRIN 6685 Overview Schema ELIGIBILITY Patients with newly diagnosed head and neck squamous cell carcinoma considered for surgical resection, with at least one side of the neck clinically N0. FDG-PET/CT Single FDG-PET/CT scan, including optional blood collection for biomarker assessment. FDG-PET/CT RESULTS REVIEW Surgeon reviews FDG-PET/CT images & reports - documents subsequent revisions to original surgical plans. SURGERY Per institutional standards. Pathology preparation follows, with reports to go to ACRIN. FOLLOW-UP Collection of health and health-related cost data as well as quality-of-life questionnaires (three follow-up time points).

8. ACRIN 6685 Overview  A total of 292 participants.  A minimum of 10 ACRIN-approved institutions are expected to enroll participants for approximately 24 months. Sample Size

9. ACRIN 6685 Overview Inclusion Criteria  Participant > 18 years of age;  Histologic confirmation of newly diagnosed SCC head and neck;  Unilateral or bilateral neck dissection planned for care (at least one clinically N0 neck side required);  CT and/or MR images taken within the four (4) weeks prior to enrollment which confirms head and neck SCC;

10. ACRIN 6685 Overview Inclusion Criteria cont.  At least one neck that is clinically N0 as defined by clinical exam (physical exam with CT and/or MRI as the gold standard of the N0 neck); Stages T2, T3, or T4. N0–N3 −excluding N2c for bilateral disease  May be considered a viable clinical option to perform neck dissection when primary cancers are at high risk for neck metastasis

11. ACRIN 6685 Overview Exclusion Criteria  pregnant and/or breastfeeding  sinonasal carcinoma  tumors in the head and neck that are not SCC  salivary gland malignancies  thyroid cancers  advanced skin cancers  nasopharyngeal carcinoma  poorly controlled diabetes  not a candidate for surgery  weighs more than 350 lbs

12. ACRIN 6685 Overview Visit: www.acrin.org/6685_protocol.aspx Contact: Irene Mahon (215-574-3249; imahon@acr.org )imahon@acr.org For more information: