1
|
Santer M, Riechelmann H, Hofauer B, Schmutzhard J, Freysinger W, Runge A, Gottfried TM, Zelger P, Widmann G, Kranebitter H, Mangesius S, Mangesius J, Kocher F, Dejaco D. Radiomic Assessment of Radiation-Induced Alterations of Skeletal Muscle Composition in Head and Neck Squamous Cell Carcinoma within the Currently Clinically Defined Optimal Time Window for Salvage Surgery-A Pilot Study. Cancers (Basel) 2023; 15:4650. [PMID: 37760620 PMCID: PMC10527389 DOI: 10.3390/cancers15184650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) frequently require primary radiochemotherapy (RCT). Despite intensity modulation, the desired radiation-induced effects observed in HNSCC may also be observed as side effects in healthy tissue, e.g., the sternocleidomastoid muscle (SCM). These side effects (e.g., tissue fibrosis) depend on the interval between the completion of RCT and restaging CT. For salvage surgery, the optimal time window for surgery is currently clinically postulated at between 6 and 12 weeks after completion of RCT. Thus, no extensive tissue fibrosis is to be expected. This interval is based on clinical studies exploring surgical complications. Studies directly exploring radiation-induced changes of the SCM in HNSCC patients are sparse. The present study quantified tissue alterations in the SCM and paravertebral musculature (PVM) after RCT, applying radiomics to determine the optimal time window for salvage surgery. Three radiomic key parameters, (1) volume, (2) mean positivity of pixels (MPP), and (3) uniformity, were extracted with mint LesionTM in the staging CTs and restaging CTs of 98 HNSCC patients. Of these, 25 were female, the mean age was 62 (±9.6) years, and 80.9% were UICC Stage IV. The mean restaging interval was 55 (±28; range 29-229) days. Only the mean volume significantly decreased after RCT, from 9.0 to 8.4 and 96.5 to 91.9 mL for the SCM and PVM, respectively (both p = 0.007, both Cohen's d = 0.28). In addition, the mean body mass index (BMI) decreased from 23.9 (±4.2) to 21.0 (±3.6) kg/m² (p < 0.001; Cohen's d = 0.9). The mean BMI decreased significantly and was correlated with the volume decrease for the SCM (r = 0.27; p = 0.007) and PVM (r = 0.41; p < 0.001). If t-test p-values were adjusted for the BMI decrease, no significant change in volumes for the SCM and PVM was observed (both p > 0.05). The present data support the clinically postulated optimal interval for salvage surgery of 6 to 12 weeks.
Collapse
Affiliation(s)
- Matthias Santer
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| | - Herbert Riechelmann
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| | - Benedikt Hofauer
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| | - Wolfgang Freysinger
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| | - Annette Runge
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| | - Timo Maria Gottfried
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| | - Philipp Zelger
- Department for Hearing, Voice and Speech Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.W.); (H.K.)
| | - Hanna Kranebitter
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.W.); (H.K.)
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Julian Mangesius
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Florian Kocher
- Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (H.R.); (B.H.); (J.S.); (W.F.); (A.R.); (T.M.G.)
| |
Collapse
|
2
|
Kim RY, Vincent AG, Shokri T, Ducic Y. Does Bulky Adenopathy in Human Papilloma Virus-Positive Oropharyngeal Squamous Cell Carcinoma Require a Planned Post-Treatment Neck Dissection for Occult Residual Disease? J Oral Maxillofac Surg 2023; 81:248-253. [PMID: 36528082 DOI: 10.1016/j.joms.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE A planned neck dissection was traditionally considered for a large nodal disease after definitive chemoradiation, yet controversy exists for the human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV OPSCC). We aimed to measure the frequency of persistent occult neck disease in planned neck dissection for HPV OPSCC presenting with a large (≥3.0 cm) nodal burden. METHODS We designed a retrospective cohort study at a single tertiary referral institution. The study population was sampled from 2006 to 2018 and subjects with HPV OPSCC and adenopathy ≥3.0 cm. Inclusion criteria encompassed subjects who completed primary chemoradiation therapy (CRT) or primary radiation therapy (RT), and subsequently underwent a planned neck dissection. We excluded subjects who did not complete therapy or had less than 1-year follow-up. Our primary predictor variable was the size of cervical adenopathy on presentation (3.0-3.9 cm, 4.0-4.9 cm, 5.0-5.9 cm, and ≥6.0 cm). Our primary outcome of interest was the presence of disease based on the histopathology review. Other variables included the demographics, primary treatment with CRT or RT, and post-treatment clinical or radiographic evidence of disease. Chi-square testing was used to compare rates of persistent disease, with varying sizes of cervical adenopathy on presentation. The alpha level for statistical significance was set at 0.05. RESULTS A total of 86 subjects were analyzed, with forty-one females and forty-five males, ranging from 36 to 77 years (mean 54.6 years). From the total study sample, 35% showed persistent disease, and 67% of those subjects had occult disease at the time of planned neck dissection. Greater than 20% of subjects had persistent disease when the nodal burden was ≥3.0 cm at presentation. Furthermore, there was a statistically significant difference in the rates of persistent microscopic disease among subjects with nodal burden of different sizes based on chi-square testing (P = .01, χ2 = 10.66). CONCLUSIONS Our data suggest that subjects with HPV OPSCC presenting with a nodal burden ≥3.0 cm are likely to have 23% chance of persistent occult neck disease after primary CRT or RT. These findings may support the routine treatment of these subjects with a planned neck dissection after initial therapy to confirm or surgically complete disease eradication.
Collapse
Affiliation(s)
- Roderick Y Kim
- Director of Fellowship in Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, TX.
| | - Aurora G Vincent
- Deputy Chief of Surgery, Facial Plastic and Reconstructive Surgery, Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA
| | - Tom Shokri
- Assistant Professor of Surgery, Department of Facial Plastic and Reconstructive Surgery, George Washington University, Washington, DC
| | - Yadranko Ducic
- Fellowship Director, Facial Plastic Surgery, Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX
| |
Collapse
|
3
|
MRI-detected residual retropharyngeal lymph node after intensity-modulated radiotherapy in nasopharyngeal carcinoma: Prognostic value and a nomogram for the pretherapy prediction of it. Radiother Oncol 2020; 145:101-108. [PMID: 31931288 DOI: 10.1016/j.radonc.2019.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the prognostic value of MRI-detected residual retropharyngeal lymph node (RRLN) at three months after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC) and second, to establish a nomogram for the pretherapy prediction of RRLN. MATERIALS AND METHODS We included 1103 patients with NPC from two hospitals (Sun Yat-Sen University Cancer Center [SYSUCC, n = 901] and Dongguan People's Hospital [DGPH, n = 202]). We evaluated the prognostic value of RRLN using Cox regression model in SYSUCC cohort. We developed a nomogram for the pretherapy prediction of RRLN using logistic regression model in SYSUCC training cohort (n = 645). We assessed the performance of this nomogram in an internal validation cohort (SYSUCC validation cohort, n = 256) and an external independent cohort (DGPH validation cohort, n = 202). RESULTS RRLN was an independent prognostic factor for OS (HR 2.08, 95% CI 1.32-3.29), DFS (HR 2.45, 95% CI 1.75-3.42), DMFS (HR 3.31, 95% CI 2.15-5.09), and LRRFS (HR 3.04, 95% CI 1.70-5.42). We developed a nomogram based on baseline Epstein-Barr virus DNA level and three RLN status-related features (including minimum axial diameter, extracapsular nodal spread, and laterality) that predicted an individual's risk of RRLN. Our nomogram showed good discrimination in the training cohort (C-index = 0.763). The favorable performance of this nomogram was confirmed in the internal and external validation cohorts. CONCLUSION MRI-detected RRLN at three months after IMRT was an unfavorable prognostic factor for patients with NPC. We developed and validated an easy-to-use nomogram for the pretherapy prediction of RRLN.
Collapse
|
4
|
Scherpelz KP, Wong AC, Lingen MW, Taxy JB, Cipriani NA. Histological features and prognostic significance of treatment effect in lymph node metastasis in head and neck squamous cell carcinoma. Histopathology 2018; 74:321-331. [PMID: 30144145 DOI: 10.1111/his.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/21/2018] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES Cervical lymph node metastasis in head and neck squamous cell carcinoma (HNSCC) is common. Pre-operative chemoradiotherapy (preCRT) and postoperative chemoradiotherapy (postCRT) is frequently employed in such patients. The prognostic value of viable SCC, treatment effect or no SCC in resected lymph nodes in patients who received or did not receive preCRT and postCRT was investigated. METHODS AND RESULTS Resected cervical lymph nodes from 146 patients with HNSCC were evaluated for viable SCC, treatment effect or no SCC. Immunostains for Ki67, cyclin D1, caspase 3 and H2AFX were performed on viable SCC or nucleate keratin debris. Clinical and histological data were correlated with tumour recurrence or persistence. Patients with nucleate keratin debris in lymph nodes had outcomes similar to those with diffuse treatment effect and no SCC. Viable tumour in lymph nodes was associated with worse prognosis in patients who received preCRT (P = 0.01). This relative worsening of prognosis was not observed in patients with oropharyngeal SCC or recurrent disease. Lower proliferation index in lymph node SCC was associated with preCRT and with worse outcomes (P = 0.0002). Overall, patients who received preCRT or postCRT had outcomes not significantly different from those who did not. CONCLUSION The presence of viable SCC in cervical lymph nodes has prognostic import when taken in context with the patient's history. Viable SCC in lymph nodes was significantly associated with worse outcome among patients with non-oropharyngeal SCC who received preCRT. Nucleate keratin debris should not be considered viable SCC in lymph nodes.
Collapse
Affiliation(s)
| | - Anthony C Wong
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Mark W Lingen
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Jerome B Taxy
- Department of Pathology, The University of Chicago, Chicago, IL, USA.,Department of Pathology and Laboratory Medicine, NorthShore University Health System, Evanston, IL, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
5
|
León X, Pardo L, Sansa A, Fernández A, Camacho V, García J, López M, Quer M. Prognostic role of extracapsular spread in planned neck dissection after chemoradiotherapy. Head Neck 2018; 40:2514-2520. [PMID: 30307665 DOI: 10.1002/hed.25390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/13/2018] [Accepted: 05/29/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the prognostic significance of nodes with extracapsular spread (ECS) in patients treated with a planned neck dissection after chemoradiotherapy. METHODS We carried out a retrospective study of 109 cN+ patients who achieved a complete response in the primary location after chemoradiotherapy and treated with a planned neck dissection. RESULTS The 5-year disease-specific survival for patients without residual metastatic nodes in the neck dissection (pN0, n = 69) was 75.7% (95% CI: 64.4%-87.0%). For patients with metastatic nodes without ECS (pN+/ECS-negative, n = 17), the corresponding figure was 74.0% (95% CI: 48.2%-99.8%), and for patients with metastatic neck nodes with ECS (pN+/ECS-positive, n = 23) it was 8.7% (95% CI: 0.0%-24.3%) (P = .0001). CONCLUSION The presence of ECS in the pathologic study of the planned neck dissections carried out after chemoradiotherapy in patients with human papillomavirus-negative (HPV-negative) head and neck squamous cell carcinoma (SCC) allows identification of a group of patients with a high risk of failure.
Collapse
Affiliation(s)
- Xavier León
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Laura Pardo
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aina Sansa
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Fernández
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Valle Camacho
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
van den Bovenkamp K, Dorgelo B, Noordhuis MG, van der Laan BFAM, van der Vegt B, Bijl HP, Roodenburg JL, van Dijk BAC, Oosting SF, Schuuring EMD, Langendijk JA, Halmos GB, Plaat BEC. Viable tumor in salvage neck dissections in head and neck cancer: Relation with initial treatment, change of lymph node size and human papillomavirus. Oral Oncol 2018; 77:131-136. [PMID: 29362119 DOI: 10.1016/j.oraloncology.2017.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/29/2017] [Accepted: 12/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To identify predictive factors for the presence of viable tumor and outcome in head and neck cancer patients who undergo therapeutic salvage neck dissections. MATERIALS AND METHODS Retrospective analysis of 76 salvage neck dissections after radiotherapy alone (n = 22), radiotherapy in combination with carboplatin/5-fluorouracil (n = 42) or with cetuximab (n = 12). RESULTS Viable tumor was detected in 41% of all neck dissections. Univariate analysis revealed initial treatment with radiotherapy without systemic therapy (OR 6.93, 95%CI: 2.28-21.07, p < .001), increased lymph node size after initial treatment compared to pretreatment CT scan (OR 20.48, 95%CI: 2.46-170.73, p = .005), more extensive neck dissections (OR 8.40, 95%CI: 2.94-23.98, p < .001), and human papillomavirus negative cancer (OR 4.22, 95%CI: 1.10-16.22, p = .036) as predictors of viable tumor. Patients with decreased or stable, but persistently enlarged lymph node size after chemoradiation had a significantly lower chance of viable tumor (OR 0.15, 95%CI: 0.05-0.41, p < .001). Disease-specific 5-year survival was 34% in case of viable tumor, and 78% when no viable tumor was found (p < .001). CONCLUSIONS Viable tumor in salvage neck dissections is associated with reduced survival. Radiotherapy alone, human papillomavirus negative cancer and increase in lymph node size, are associated with viable tumor in salvage neck dissections. In case of decreased or stable lymph node size after chemoradiation, watchful waiting could be considered.
Collapse
Affiliation(s)
- Karlijn van den Bovenkamp
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
| | - Bart Dorgelo
- Department of Radiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Maartje G Noordhuis
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Hendrik P Bijl
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Jan L Roodenburg
- Department of Oral and Maxillofacial Surgery, Section of Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands; Comprehensive Cancer Organisation The Netherlands (IKNL), P.O. Box 19.079, 3501DB Utrecht, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Ed M D Schuuring
- Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| |
Collapse
|
7
|
Galloway TJ, Zhang QE, Nguyen-Tan PF, Rosenthal DI, Soulieres D, Fortin A, Silverman CL, Daly ME, Ridge JA, Hammond JA, Le QT. Prognostic Value of p16 Status on the Development of a Complete Response in Involved Oropharynx Cancer Neck Nodes After Cisplatin-Based Chemoradiation: A Secondary Analysis of NRG Oncology RTOG 0129. Int J Radiat Oncol Biol Phys 2016; 96:362-371. [PMID: 27478170 PMCID: PMC5078986 DOI: 10.1016/j.ijrobp.2016.05.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the relationship between p16 status and the regional response of patients with node-positive oropharynx cancer treated on NRG Oncology RTOG 0129. METHODS AND MATERIALS Patients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on RTOG 0129 were analyzed. Pathologic complete response (pCR) rates in patients treated with a postchemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher exact test. Patients managed expectantly were compared with those treated with a neck dissection. RESULTS Ninety-nine (34%) of 292 patients with node-positive oropharynx cancer and known p16 status underwent a posttreatment neck dissection (p16-positive: n=69; p16-negative: n=30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range, 17-169) days after completion of chemoradiation. Neither the pretreatment nodal stage (P=.71) nor the postradiation, pre-neck dissection clinical/radiographic neck assessment (P=.42) differed by p16 status. A pCR was more common among p16-positive patients (78%) than p16-negative patients (53%, P=.02) and was associated with a reduced incidence of local-regional failure (hazard ratio 0.33, P=.003). On multivariate analysis of local-regional failure, a test for interaction between pCR and p16 status was not significant (P=.37). One-hundred ninety-three (66%) of 292 of initially node-positive patients were managed without a posttreatment neck dissection. Development of a clinical (cCR) was not significantly influenced by p16-status (P=.42). Observed patients with a clinical nodal CR had disease control outcomes similar to those in patients with a pCR neck dissection. CONCLUSIONS Patients with p16-positive tumors had significantly higher pCR and locoregional control rates than those with p16-negative tumors.
Collapse
Affiliation(s)
| | - Qiang Ed Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | - Denis Soulieres
- Centre Hospitalier de l'Universite de Montreal-Notre Dame, Montréal, Québec, Canada
| | - André Fortin
- L Hotel-Dieu de Quebec, Québec City, Québec, Canada
| | - Craig L Silverman
- The James Brown Cancer Center-University of Louisville, Louisville, Kentucky
| | - Megan E Daly
- University of California Davis Medical Center, Sacramento, California
| | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, California
| |
Collapse
|
8
|
Studer G, Huber GF, Holz E, Glanzmann C. Less may be more: nodal treatment in neck positive head neck cancer patients. Eur Arch Otorhinolaryngol 2016; 273:1549-56. [PMID: 25920604 PMCID: PMC4858567 DOI: 10.1007/s00405-015-3634-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/17/2015] [Indexed: 11/09/2022]
Abstract
Ongoing debates about the need and extent of planned neck dissection (PND), and required nodal radiation doses volumes lead to this evaluation. Aim was to assess nodal control after definitive intensity modulated radiation therapy (IMRT ± systemic therapy) followed by PND in our head neck cancer cohort with advanced nodal disease. Between 01/2005 and 12/2013, 99 squamous cell cancer HNC patients with pre-therapeutic nodal metastasis ≥3 cm were treated with definitive IMRT followed by PND. In addition, outcome in 103 patients with nodal relapse after IMRT and observation only (no-PND cohort) were analyzed. Prior to PND, PET-CT, fine needle aspirations, ultrasound and palpation were assessed regarding its predictive value. Patterns of nodal relapse were assessed in patients with isolated neck failure after definitive IMRT alone. 70/99 (70 %) PND specimens showed histopathological complete response (hCR), which translated into statistically significantly superior survival compared with partial response (hPR) with 4-year overall survival, disease specific survival and nodal control rates of 90/83/96 vs 67/60/78 % (p = 0.002/0.001/0.003). 1/99 patient developed isolated subsequent nodal disease. 64/2147 removed nodes contained viable tumor (3 %). Predictive information of the performed diagnostic investigations was not reliable. 17/70 hCR patients showed true negative findings in available three to four investigations (0/29 hPR). 27/103 no-PND patients developed isolated neck disease (26 %) with successful salvage in 21/24 [88 %, or 21/27 (78 %)]. Nearly all failures occurred in the prior nodal gross tumor volume area. A more restrictive approach regarding PND and/or nodal IMRT dose-volumes may be justified.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Combined Modality Therapy/methods
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Lymphatic Irradiation
- Lymphatic Metastasis
- Male
- Middle Aged
- Neck Dissection
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Radiotherapy, Intensity-Modulated
- Salvage Therapy
Collapse
Affiliation(s)
- Gabriela Studer
- />Department of Radiation Oncology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Gerhard F. Huber
- />Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Edna Holz
- />Department of Radiation Oncology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Glanzmann
- />Department of Radiation Oncology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
9
|
Up-front neck dissection followed by definitive (chemo)-radiotherapy in head and neck squamous cell carcinoma: Rationale, complications, toxicity rates, and oncological outcomes – A systematic review. Radiother Oncol 2016; 119:185-93. [DOI: 10.1016/j.radonc.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/05/2016] [Accepted: 03/02/2016] [Indexed: 12/25/2022]
|
10
|
Trufelli DC, Matos LLD, Santana TA, Capelli FDA, Kanda JL, Del Giglio A, Castro Junior GD. Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy. Braz J Otorhinolaryngol 2015; 81:498-504. [PMID: 26277829 PMCID: PMC9449043 DOI: 10.1016/j.bjorl.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 10/08/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction Chemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck. Objective To determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO. Methods Data were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy. Results A total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%; p = 0.049). Conclusion The presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.
Collapse
Affiliation(s)
| | - Leandro Luongo de Matos
- Department of Public Health (Biostatistics), Faculdade de Medicina do ABC, Santo André, SP, Brazil.
| | | | | | - Jossi Ledo Kanda
- Discipline of Head and Neck Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Auro Del Giglio
- Discipline of Oncology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | | |
Collapse
|
11
|
Hamoir M, Schmitz S, Gregoire V. The role of neck dissection in squamous cell carcinoma of the head and neck. Curr Treat Options Oncol 2015; 15:611-24. [PMID: 25228145 DOI: 10.1007/s11864-014-0311-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
ORIGINAL STATEMENT Lymph node metastases in the neck are a major prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). Assessment and treatment of lymph nodes in the neck are of utmost importance. Inappropriate management of lymph node metastases can result in regional failure. Radical neck dissection has been and is still considered the "gold standard" for the surgical management of lymph node metastases of HNSCC. However, the philosophy of treatment of the neck has evolved during the last decades. Surgeons progressively realized that extensive neck dissections were associated with a higher morbidity but not always with a better oncologic outcome than more limited procedures. Today, a comprehensive therapeutic approach of the neck is multidisciplinary, taking into account the patient's quality of life without jeopardizing cure and survival. A better understanding of the patterns of lymph node metastasis promoted the use of selective neck dissection in selected patients. Sentinel lymph node biopsy is a reliable diagnostic procedure for staging the neck in node-negative early oral cavity squamous cell carcinoma. With increasing use of chemoradiation in locally advanced HNSCC, paradigms are evolving. Currently, there are strong arguments supporting the position that neck dissection is no longer justified in patients without clinically residual disease in the neck.
Collapse
Affiliation(s)
- Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital, Hippocrate Avenue, 10, 1200, Brussels, Belgium,
| | | | | |
Collapse
|
12
|
No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression. Eur Arch Otorhinolaryngol 2015; 273:1841-8. [DOI: 10.1007/s00405-015-3675-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/25/2015] [Indexed: 11/26/2022]
|
13
|
Huang SH, Patel S, O'Sullivan B, Shen X, Xu W, Weinreb I, Perez-Ordonez B, Irish J, Waldron J, Gullane P, Gilbert R, Brown D, Kim J, Freeman J, de Almeida JR, Goldstein D. Longer survival in patients with human papillomavirus-related head and neck cancer after positive postradiation planned neck dissection. Head Neck 2014; 37:946-52. [DOI: 10.1002/hed.23690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/14/2014] [Accepted: 03/11/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - Samip Patel
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - Xiaowei Shen
- Department of Biostatistics; Princess Margaret Cancer Centre; Toronto Canada
| | - Wei Xu
- Department of Biostatistics; Princess Margaret Cancer Centre; Toronto Canada
| | - Ilan Weinreb
- Department of Pathology; Princess Margaret Centre; Toronto Canada
| | | | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - John Waldron
- Department of Radiation Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - Dale Brown
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - John Kim
- Department of Radiation Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology; Princess Margaret Cancer Centre/University of Toronto; Toronto Canada
| |
Collapse
|
14
|
Hanai N, Ozawa T, Hirakawa H, Suzuki H, Fukuda Y, Hasegawa Y. The nodal response to chemoselection predicts the risk of recurrence following definitive chemoradiotherapy for pharyngeal cancer. Acta Otolaryngol 2014; 134:865-71. [PMID: 25022795 DOI: 10.3109/00016489.2014.894252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS The poor response of neck tumors to induction chemotherapy (ICT) as chemoselection is related to a significantly worse prognosis, including higher risks of local recurrence and/or distant metastasis, after definitive chemoradiotherapy (CRT). OBJECTIVES Neck dissection is frequently performed to treat residual lymph nodes after CRT for the purpose of locoregional control; however, the prognosis of patients with pathologically proven residual neck tumors is poor, and no methods for predicting unfavorable results before CRT have been established. Therefore, in the present study, we focused on the response of lymph nodes to ICT and its relationship with the prognosis among patients treated with chemoselection. METHODS We retrospectively reviewed a total of 27 oropharyngeal and 24 hypopharyngeal squamous cell carcinoma stage III/IV consecutive patients with cervical lymph node metastasis who exhibited a response of >50% in the primary tumor to ICT followed by concurrent definitive CRT. RESULTS The relapse-free survival of the patients who responded (partial response/complete response, PR/CR) to ICT was significantly superior to that of the patients who did not respond (stable disease, SD) to ICT (p = 0.008).
Collapse
Affiliation(s)
- Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital , Nagoya , Japan
| | | | | | | | | | | |
Collapse
|
15
|
Efficacy of Neck Dissection in the Management of Isolated Nodal Recurrence after Head and Neck Cancer Treatment. Curr Oncol Rep 2013; 15:142-5. [DOI: 10.1007/s11912-013-0294-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
16
|
Denaro N, Russi EG, Numico G, Pazzaia T, Vitiello R, Merlano MC. The role of neck dissection after radical chemoradiation for locally advanced head and neck cancer: should we move back? Oncology 2013; 84:174-85. [PMID: 23306430 DOI: 10.1159/000346132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/19/2012] [Indexed: 01/12/2023]
Abstract
Until a few decades ago neck dissection (ND) was the standard surgical approach for node-positive tumours. Nowadays patients with locally advanced head and neck cancer can be treated with definitive chemoradiation (CRT), which includes the treatment of the neck; however, results on residual viable tumour after conservative treatment are heterogeneous and depend on initial node stage and primary treatment. Many authors accept adjuvant surgery in patients with N2-3 disease. Regardless of the results of upfront CRT, even if there is no evidence of lymph node metastases, when the risk for persistent positive neck nodes exceeds 15-20%, elective ND might be indicated. However, despite the diffusion of innovative technologies and therapies, there are controversies about both response evaluation and surgical management of initially involved neck nodes after definitive CRT and organ preservation treatment. In this paper we will analyse state of art of neck evaluation after CRT and discuss the role of ND.
Collapse
Affiliation(s)
- N Denaro
- Messina University, Messina, Italy.
| | | | | | | | | | | |
Collapse
|
17
|
Thariat J, Hamoir M, Garrel R, Cosmidis A, Dassonville O, Janot, Righini CA, Vedrine PO, Prades JM, Lacau-Saint-Guily J, Jegoux F, Malard O, De Mones E, Benlyazid A, Bensadoun RJ, Baujat B, Merol JC, Ferron C, Scavennec C, Salvan D, Mallet Y, Moriniere S, Vergez S, Choussy O, Dollivet G, Guevara N, Ceruse P, De Raucourt D, Lallemant B, Lawson G, Lindas P, Poupart M, Duflo S, Dufour X. Management of the Neck in the Setting of Definitive Chemoradiation: Is There a Consensus? A GETTEC Study. Ann Surg Oncol 2012; 19:2311-9. [DOI: 10.1245/s10434-012-2275-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Indexed: 11/18/2022]
|
18
|
Incidence of nodal disease after nonsurgical therapy in head and neck squamous cell carcinoma patients with bilateral neck disease: can a bilateral neck dissection be avoided? Am J Clin Oncol 2012; 36:188-91. [PMID: 22391429 DOI: 10.1097/coc.0b013e3182436eda] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We evaluated whether classifying 1 side of a patients' neck as "high risk" would help in deciding the extent of neck dissection in patients with bilateral nodal disease. METHODS We conducted a retrospective review of 44 patients (88 heminecks) with head and neck squamous cell carcinoma who had bilateral nodal disease and received definitive chemoradiotherapy (CRT). For lateralized lesions (70%), the ipsilateral neck was designated as the "high-risk" neck. For midline lesions, pre-CRT and post-CRT computed tomography scans were used to stage each side of the neck (hemineck); the higher staged hemineck was designated as the "high-risk" neck. RESULTS Twenty-seven patients had died at the time of analysis. Patients had a median follow-up of 27.8 months (range, 6 to 150 mo). Two-year neck control and overall survival were 83% and 56%, respectively. Sixty-two heminecks (71%) were dissected. A total of 6/22 (27%) "low-risk" necks were positive after CRT if the "high-risk" neck was positive versus 0/22 if the "high-risk" neck was negative (P=0.02). CONCLUSIONS Identifying the more "high-risk" neck may be useful when deciding the extent of neck dissection after CRT. For patients with bilateral nodal disease treated with CRT, dissection of the "low-risk" hemineck may be omitted if the "high-risk" neck is pathologically negative.
Collapse
|
19
|
The role of neck dissection in the setting of chemoradiation therapy for head and neck squamous cell carcinoma with advanced neck disease. Oral Oncol 2012; 48:203-10. [DOI: 10.1016/j.oraloncology.2011.10.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 10/18/2011] [Accepted: 10/19/2011] [Indexed: 11/23/2022]
|
20
|
Huang SH, O'Sullivan B, Weinreb I, Perez-Ordonez B, Irish J, Waldron J, Gullane P, Gilbert R, Brown D, Cummings B, Kim J, Freeman J, Witterick I, Goldstein D. Patterns of failure and histopathologic outcome predictors following definitive radiotherapy and planned neck dissection with residual disease. Head Neck 2011; 34:913-22. [DOI: 10.1002/hed.21854] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 11/06/2022] Open
|
21
|
Dhiwakar M, Robbins KT, Vieira F, Rao K, Malone J. Selective neck dissection as an early salvage intervention for clinically persistent nodal disease following chemoradiation. Head Neck 2011; 34:188-93. [PMID: 21472879 DOI: 10.1002/hed.21707] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/06/2010] [Accepted: 10/26/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the efficacy of selective neck dissection (SND) performed for persistent nodal disease after chemoradiation. METHODS Patients treated with definitive chemoradiation for squamous cell carcinoma of the head and neck who subsequently underwent SND for early salvage of clinically persistent nodal disease were evaluated. The primary outcome measure was regional disease control. RESULTS A total of 62 patients underwent 69 SND procedures. The median time interval between completion of chemoradiation and neck dissection was 10 weeks. There was evidence of residual tumor in 32 neck dissection specimens (46%). Forty patients (65%) remained free of disease, whereas the remaining 22 patients (35%) developed a recurrence, among which 4 were regional. Of these, 3 occurred in the contralateral neck and only 1 occurred in the targeted (ipsilateral) neck. CONCLUSIONS SND is an effective early salvage intervention for persistent nodal disease in patients treated with chemoradiation.
Collapse
Affiliation(s)
- Muthuswamy Dhiwakar
- Division of Otolaryngology-Head and Neck Surgery, Simmons Cancer Institute at Southern Illinois University, Springfield, Illinois
| | | | | | | | | |
Collapse
|
22
|
Dhiwakar M, Robbins KT, Rao K, Vieira F, Malone J. Efficacy of selective neck dissection for nodal metastasis with involvement of nonlymphatic structures. Head Neck 2010; 33:1099-105. [DOI: 10.1002/hed.21587] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 06/29/2010] [Accepted: 07/23/2010] [Indexed: 10/18/2022] Open
|
23
|
Ganly I, Bocker J, Carlson DL, D'Arpa S, Coleman M, Lee N, Pfister DG, Shah JP, Patel SG. Viable tumor in postchemoradiation neck dissection specimens as an indicator of poor outcome. Head Neck 2010; 33:1387-93. [PMID: 21928410 DOI: 10.1002/hed.21612] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the prognostic significance of viable tumor in postchemoradiation neck dissection specimens in patients with squamous cell carcinoma of the laryngopharynx. METHODS Retrospective analysis identified 181 patients treated with primary concurrent chemoradiation for carcinoma of the laryngopharynx at Memorial Sloan-Kettering Cancer Center between the years 1995 and 2005. Of these, 56 patients had a comprehensive neck dissection either as a planned or salvage procedure. Neck dissection specimens were analyzed by a single pathologist for the presence of viable tumor. The presence of viable tumor was correlated to the timing of neck dissection after chemoradiation and to tumor response. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan-Meier method, and correlation to tumor viability was determined with the log-rank test. RESULTS Nineteen (33%) patients had viable tumor in their neck dissection specimens. Viable tumor was higher in patients who had a less-than-complete response to chemoradiation compared with those who had a complete response (42% vs 25%, p = .1). There was no correlation to timing of neck dissection. The 5-year OS, DSS, and RFS were significantly lower in patients who had viable tumor in their neck dissection specimens (OS 49% vs 93%, p = .0005; DSS 56% versus 93%, p = .003; RFS 40% vs 75%, p = .004). CONCLUSIONS Patients with viable tumor in postchemoradiation neck dissection specimens had a poorer outcome compared with patients with no viable tumor.
Collapse
Affiliation(s)
- Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
This article reviewed the current state of the art in head and neck oncology. These include very important and stimulating new areas of interest including the marked acceptance of chemoradiation in favor of surgery in patients with cancer of the head and neck. The concept of HPV as a cause of cancer of the oropharynx is relatively new and very important in the epidemiology of these tumors. New modalities such as PET CT scanning and robotic surgery are discussed and appear to be very important in management of cancer of the head and neck. Endoscopic endonasal skull base surgery is another new high technology contribution to the field of head and neck surgery as is the use of endoscopic assisted thyroid surgery. These and other new concepts are discussed in this manuscript.
Collapse
|
25
|
Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
26
|
Pattani KM, Califano J, Sanguineti G. Level V involvement in patients with early T-stage, node-positive oropharyngeal carcinoma. Laryngoscope 2009; 119:2165-9. [DOI: 10.1002/lary.20616] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
27
|
Sher DJ, Tishler RB, Annino D, Punglia RS. Cost-effectiveness of CT and PET-CT for determining the need for adjuvant neck dissection in locally advanced head and neck cancer. Ann Oncol 2009; 21:1072-7. [PMID: 19833820 DOI: 10.1093/annonc/mdp405] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with node-positive head and neck squamous cell carcinomas (HNC) have a significant risk of residual disease (RD) in the neck after treatment, despite optimal chemoradiotherapy (CRT). Adjuvant neck dissection (ND) after CRT has been considered standard treatment, but its morbidity has led investigators to consider using post-CRT imaging to determine the need for surgery. We analyzed the cost-effectiveness of computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) as predictors of the need for ND compared with ND for all patients. MATERIALS AND METHODS We developed a Markov model to describe health states in the 5 years after CRT for HNC in a 50-year-old man. We compared three strategies: dissect all patients, dissect patients with RD on CT, and dissect patients with RD on PET-CT. Probabilistic sensitivity analyses were carried out to model uncertainty in PET-CT performance, up-front and salvage dissection costs, and patient utilities. RESULTS ND only for patients with RD on PET-CT was the dominant strategy over a wide range of realistic and exaggerated assumptions. Probabilistic sensitivity analyses confirmed that the PET-CT strategy was almost certainly cost-effective at a societal willingness-to-pay threshold of $500,000/quality-adjusted life year. CONCLUSION Adjuvant ND reserved for patients with RD on PET-CT is the dominant and cost-effective strategy.
Collapse
Affiliation(s)
- D J Sher
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
28
|
Thariat J, Hamoir M, Janot F, De Mones E, Marcy PY, Carrier P, Bozec A, Guevara N, Albert S, Vedrine PO, Graff P, Peyrade F, Hofman P, Santini J, Bourhis J, Lapeyre M. [Neck dissection following chemoradiation for node positive head and neck carcinomas]. Cancer Radiother 2009; 13:758-70. [PMID: 19692283 DOI: 10.1016/j.canrad.2009.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/14/2009] [Accepted: 05/02/2009] [Indexed: 11/19/2022]
Abstract
The optimal timing and extent of neck dissection in the context of chemoradiation for head and neck cancer remains controversial. For some institutions, it is uncertain whether neck dissection should still be performed upfront especially for cystic nodes. For others, neck dissection can be performed after chemoradiation and can be omitted for N1 disease as long as a complete response to chemoradiation is obtained. The question is debated for N2 and N3 disease even after a complete response as the correlation between radiological and clinical assessment and pathology may not be reliable. Response rates are greater than or equal to 60% and isolated neck failures are less than or equal to 10% with current chemoradiation protocols. Some therefore consider that systematic upfront or planned neck dissection would lead to greater than or equal to 50% unnecessary neck dissections for N2-N3 disease. Positron-emission tomography (PET) scanning to assess treatment response and have shown a very high negative predictive value of greater than or equal to 95% when using a standard uptake value of 3 for patients with a negative PET at four months after the completion of therapy. These data may support the practice of observing PET-negative necks. More evidence-based data are awaited to assess the need for neck dissection on PET. Selective neck dissection based on radiological assessment and peroperative findings and not exclusively on initial nodal stage may help to limit morbidity and to improve the quality of life without increasing the risk of neck failure. Adjuvant regional radiation boosts might be discussed on an individual basis for aggressive residual nodal disease with extracapsular spread and uncertain margins but evidence is missing. Medical treatments aiming at reducing the metastatic risk especially for N3 disease are to be evaluated.
Collapse
Affiliation(s)
- J Thariat
- Département de radiothérapie, oncologie, centre de lutte contre le cancer Antoine-Lacassagne, 33 avenue Valombrose, Nice cedex 2, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|