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Molteni G, Comini L, Le Pera B, Bassani S, Ghirelli M, Martone A, Mattioli F, Nocini R, Santoro R, Spinelli G, Presutti L, Marchioni D, Mannelli G. Salvage neck dissection for isolated neck recurrences in head and neck tumors: Intra and postoperative complications. J Surg Oncol 2021; 124:740-750. [PMID: 34152604 DOI: 10.1002/jso.26576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/04/2021] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. METHODS This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. RESULTS Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. CONCLUSIONS IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.
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Affiliation(s)
- Gabriele Molteni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Lara Comini
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Beatrice Le Pera
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Sara Bassani
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Michael Ghirelli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Andrea Martone
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Francesco Mattioli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Roberto Santoro
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Livio Presutti
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Giuditta Mannelli
- Head and Neck Oncology and Robotic Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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2
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Costantino A, Mercante G, D'Ascoli E, Ferreli F, Di Tommaso L, Franzese C, Giannitto C, Casale M, Spriano G, De Virgilio A. Accuracy of fine-needle aspiration cytology in detecting cervical node metastasis after radiotherapy: Systematic review and meta-analysis. Head Neck 2020; 43:987-996. [PMID: 33166002 DOI: 10.1002/hed.26536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To define the accuracy of fine-needle aspiration cytology (FNAC) in diagnosing persistent or recurrent neck metastases in previously irradiated patients. METHODS The study was performed according to the PRISMA-DTA guidelines. RESULTS A total of 382 FNACs were used for calculation of diagnostic accuracy parameters. The overall pooled sensitivity and specificity in detecting malignant nodes were 69.1% (95% CI: 56.3%-80.7%; I2 = 79.5%) and 84.2% (95% CI: 71.8%-93.5%; I2 = 87.0%), respectively. Cumulative diagnostic odds ratio (DOR) was 16.54 (95% CI: 4.89-38.99; I2 = 65.8%), while cumulative positive and negative likelihood ratio (PLR and NLR) were 5.4 (95% CI: 2.3-11.2) and 0.37 (95% CI: 0.22-0.54), respectively. CONCLUSIONS FNAC alone could not guide the decision to perform a salvage neck dissection in previously irradiated patients, but its results should be assessed in relation to the specific clinical context.
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Affiliation(s)
- Andrea Costantino
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Elisa D'Ascoli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Luca Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Pathology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Radiotherapy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Caterina Giannitto
- Radiology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Manuele Casale
- Unit of Otolaryngology, UOS ORL TI, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
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3
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Prestwich RJD, Arunsingh M, Zhong J, Dyker KE, Vaidyanathan S, Scarsbrook AF. Second-look PET-CT following an initial incomplete PET-CT response to (chemo)radiotherapy for head and neck squamous cell carcinoma. Eur Radiol 2019; 30:1212-1220. [PMID: 31485835 DOI: 10.1007/s00330-019-06401-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The limited positive predictive value of an incomplete response on PET-CT following (chemo)radiotherapy for head and neck squamous cell carcinoma (HNSCC) means that the optimal management strategy remains uncertain. The aim of the study is to assess the utility of a 'second-look' interval PET-CT. METHODS Patients with HNSCC who were treated with (chemo)radiotherapy between 2008 and 2017 and underwent (i) baseline and (ii) response assessment PET-CT and (iii) second-look PET-CT following incomplete (positive or equivocal scan) response were included. Endpoints were conversion rate to complete response (CR) and test characteristics of the second-look PET-CT. RESULTS Five hundred sixty-two patients with HNSCC underwent response assessment PET-CT at a median of 17 weeks post-radiotherapy. Following an incomplete response on PET-CT, 40 patients underwent a second-look PET-CT at a median of 13 weeks (range 6-25) from the first response PET-CT. Thirty-four out of 40 (85%) patients had oropharyngeal carcinoma. Twenty-four out of 40 (60%) second-look PET-CT scans converted to a complete locoregional response. The primary tumour conversion rate was 15/27 (56%) and the lymph node conversion rate was 14/19 (74%). The sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the second-look PET-CT were 75%, 75%, 25% and 96% for the primary tumour and 100%, 92%, 40% and 100% for lymph nodes. There were no cases of progression following conversion to CR in the primary site or lymph nodes. CONCLUSIONS The majority of patients who undergo a second-look PET-CT convert to a CR. The NPV of a second-look PET-CT is high, suggesting the potential to avoid surgical intervention. KEY POINTS • PET-CT is a useful tool for response assessment following (chemo)radiotherapy for head and neck squamous cell carcinoma. • An incomplete response on PET-CT has a limited positive predictive value and optimal management is uncertain. • These data show that with a 'second-look' interval PET-CT, the majority of patients convert to a complete metabolic response. When there is doubt about clinical and radiological response, a 'second-look' PET-CT can be used to spare patients unnecessary surgical intervention.
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Affiliation(s)
- Robin J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, LS9 7TF, UK. .,Level 4, Leeds Cancer Centre, St. James's University Hospital, Beckett St., Leeds, LS9 7TF, UK.
| | - Moses Arunsingh
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, LS9 7TF, UK
| | - Jim Zhong
- Department of Nuclear Medicine and Radiology, Leeds Cancer Centre, Leeds, UK
| | - Karen E Dyker
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, LS9 7TF, UK
| | - Sriram Vaidyanathan
- Department of Nuclear Medicine and Radiology, Leeds Cancer Centre, Leeds, UK
| | - Andrew F Scarsbrook
- Department of Nuclear Medicine and Radiology, Leeds Cancer Centre, Leeds, UK.,Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Elkashty OA, Ashry R, Tran SD. Head and neck cancer management and cancer stem cells implication. Saudi Dent J 2019; 31:395-416. [PMID: 31700218 PMCID: PMC6823822 DOI: 10.1016/j.sdentj.2019.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) arise in the mucosal linings of the upper aerodigestive tract and are heterogeneous in nature. Risk factors for HNSCCs are smoking, excessive alcohol consumption, and the human papilloma virus. Conventional treatments are surgery, radiotherapy, chemotherapy, or a combined modality; however, no international standard mode of therapy exists. In contrast to the conventional model of clonal evolution in tumor development, there is a newly proposed theory based on the activity of cancer stem cells (CSCs) as the model for carcinogenesis. This “CSC hypothesis” may explain the high mortality rate, low response to treatments, and tendency to develop multiple tumors for HNSCC patients. We review current knowledge on HNSCC etiology and treatment, with a focus on CSCs, including their origins, identifications, and effects on therapeutic options.
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Key Words
- ABC, ATP-binding cassette transporters
- ATC, amplifying transitory cell
- Antineoplastic agents
- BMI-1, B cell-specific Moloney murine leukemia virus integration site 1
- Cancer stem cells
- Cancer treatment
- Carcinoma
- EGFR, epidermal growth factor receptor
- HIFs, hypoxia-inducible factors
- Head and neck cancer
- MDR1, Multidrug Resistance Protein 1
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- PI3K, phosphatidylinositol-4,5-bisphosphate 3-kinase
- Squamous cell
- TKIs, tyrosine kinase inhibitors
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Affiliation(s)
- Osama A Elkashty
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ramy Ashry
- Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Simon D Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada
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5
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Slevin F, Ermiş E, Vaidyanathan S, Sen M, Scarsbrook AF, Prestwich RJ. Accuracy of [ 18Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2017; 11:1179554917713005. [PMID: 28659717 PMCID: PMC5476423 DOI: 10.1177/1179554917713005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The accuracy of response assessment positron emission tomography (PET)-computed tomography (CT) following radiotherapy with or without chemotherapy for laryngeal/hypopharyngeal squamous cell carcinoma is uncertain. METHODS In all, 35 patients with laryngeal or hypopharyngeal squamous cell carcinoma who were treated between 2009 and 2014 with (chemo)radiotherapy were identified. The accuracy of response assessment PET-CT was made by correlation with clinical follow-up and pathological findings. RESULTS Of the 35 patients, 20 (57%) had an overall complete metabolic response. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for response assessment [18Fluorine]-fluoro-2-deoxy-d-glucose (FDG) PET-CT for primary and nodal sites, respectively, were 100%, 73%, 46%, and 100% and 83%, 95%, 83%, and 95%. CONCLUSIONS Response assessment FDG PET-CT following (chemo)radiotherapy for laryngeal and hypopharyngeal carcinomas has a high NPV for both primary site and lymph nodes and can be used to guide treatment decisions. The PPV of residual FDG uptake at the primary tumour site is limited and requires examination and biopsy confirmation.
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Affiliation(s)
- Finbar Slevin
- Department of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - Ekin Ermiş
- Department of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - Sriram Vaidyanathan
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
| | - Mehmet Sen
- Department of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - Andrew F Scarsbrook
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
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6
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Slevin F, Subesinghe M, Ramasamy S, Sen M, Scarsbrook AF, Prestwich RJD. Assessment of outcomes with delayed (18)F-FDG PET-CT response assessment in head and neck squamous cell carcinoma. Br J Radiol 2015; 88:20140592. [PMID: 26081447 DOI: 10.1259/bjr.20140592] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To assess the accuracy of a 4-month post-(chemo)radiotherapy 18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)-CT for head and neck squamous cell carcinoma (HNSCC). METHODS 105 patients who underwent a baseline and response assessment (18)F-FDG PET-CT scan between 2008 and April 2013 were identified. (18)F-FDG PET-CT outcomes were analysed with reference to clinicopathological outcomes. RESULTS 79 of 105 (75%) (18)F-FDG PET-CT scans demonstrated a complete metabolic response; 19 of 101 (19%) for assessable primary tumours were positive; and 19 of 93 (20%) for patients with nodal disease were equivocal (n = 10) or positive (n = 9). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for primary and nodal disease were 90%, 89%, 47%, 99% and 91%, 89%, 53% and 99%, respectively. Eight of nine patients with a positive nodal response scan had clinicopathological evidence of residual nodal disease (PPV, 89%). 2 of 10 patients with equivocal nodal responses had clinicopathological evidence of residual nodal disease (PPV, 20%). CONCLUSION (18)F-FDG PET-CT 4 months post treatment has a very high NPV. A positive (18)F-FDG PET-CT has a high PPV for residual nodal disease. By contrast, patients who have an equivocal nodal response have a low PPV. ADVANCES IN KNOWLEDGE Response assessment (18)F-FDG PET-CT is a valuable tool in guiding the selective use of neck dissection following (chemo)radiotherapy for HNSCC. An equivocal lymph node response has a limited predictive value for persistent disease, and optimal management remains a clinical challenge.
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Affiliation(s)
- F Slevin
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - M Subesinghe
- 2 Department of Radiology, St James's Institute of Oncology, Leeds, UK.,3 Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK
| | - S Ramasamy
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - M Sen
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - A F Scarsbrook
- 2 Department of Radiology, St James's Institute of Oncology, Leeds, UK.,3 Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK
| | - R J D Prestwich
- 1 Department of Clinical Oncology, St James's Institute of Oncology, Leeds, UK
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Coskun HH, Medina JE, Robbins KT, Silver CE, Strojan P, Teymoortash A, Pellitteri PK, Rodrigo JP, Stoeckli SJ, Shaha AR, Suçrez C, Hartl DM, de Bree R, Takes RP, Hamoir M, Pitman KT, Rinaldo A, Ferlito A. Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma. Head Neck 2015; 37:915-26. [PMID: 24623715 PMCID: PMC4991629 DOI: 10.1002/hed.23689] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/03/2014] [Accepted: 03/08/2014] [Indexed: 12/11/2022] Open
Abstract
Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach.
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Affiliation(s)
- H. Hakan Coskun
- Department of Otolaryngology–Head and Neck Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Jesus E. Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - K. Thomas Robbins
- Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Carl E. Silver
- Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Afshin Teymoortash
- Department of Otolaryngology–Head and Neck Surgery, University of Marburg, Marburg, Germany
| | - Phillip K. Pellitteri
- Department of Otolaryngology–Head and Neck Surgery, Guthrie Health System, Sayre, Pennsylvania
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology–Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
| | - Ashok R. Shaha
- Head and Neck Service, Memorial Sloan–Kettering Cancer Center, New York, New York
| | - Carlos Suçrez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Dana M. Hartl
- Department of Otolaryngology–Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France
- Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Remco de Bree
- Department of Otolaryngology–Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert P. Takes
- Department of Otolaryngology–Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - Karen T. Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona
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8
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Garden AS, Gunn GB, Hessel A, Beadle BM, Ahmed S, El-naggar A, Fuller CD, Byers LA, Phan J, Frank SJ, Morrison WH, Kies MS, Rosenthal DI, Sturgis EM. Management of the lymph node-positive neck in the patient with human papillomavirus-associated oropharyngeal cancer. Cancer 2014; 120:3082-8. [PMID: 24898672 PMCID: PMC4172550 DOI: 10.1002/cncr.28831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/08/2014] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The goal of the current study was to assess the rates of recurrence in the neck for patients with lymph node-positive human papillomavirus-associated cancer of the oropharynx who were treated with definitive radiotherapy (with or without chemotherapy). METHODS This is a single-institution retrospective study. Methodology included database search, and statistical testing including frequency analysis, Kaplan-Meier tests, and comparative tests including chi-square, logistic regression, and log-rank. RESULTS The cohort consisted of 401 patients with lymph node-positive disease who underwent radiotherapy between January 2006 and June 2012. A total of 388 patients had computed tomography restaging, and 251 had positron emission tomography and/or ultrasound as a component of their postradiation staging. Eighty patients (20%) underwent neck dissection, and 21 patients (26%) had a positive specimen. The rate of neck dissection increased with increasing lymph node stage, and was lower in patients who had positron emission tomography scans or ultrasound in addition to computed tomography restaging. The median follow-up was 30 months. The 2-year actuarial neck recurrence rate was 7% and 5%, respectively, in all patients and those with local control. Lymph node recurrence rates were greater in current smokers (P = .008). There was no difference in lymph node recurrence rates noted between patients who did and those who did not undergo a neck dissection (P = .4) CONCLUSIONS: A treatment strategy of (chemo)radiation with neck dissection performed based on response resulted in high rates of regional disease control in patients with human papillomavirus-associated oropharyngeal cancer.
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Affiliation(s)
- Adam S. Garden
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Gary B. Gunn
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Amy Hessel
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Beth M. Beadle
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Salmaan Ahmed
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Adel El-naggar
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Clifton D. Fuller
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Lauren A. Byers
- Department of Thoracic/Head and Neck Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Jack Phan
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Steven J. Frank
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - William H. Morrison
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Merill S. Kies
- Department of Thoracic/Head and Neck Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - David I. Rosenthal
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
| | - Erich M. Sturgis
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030
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9
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Garden AS, Fuller CD. Letter to the Editor regarding transoral laser microsurgery followed by radiotherapy in advanced oropharyngeal cancer. Head Neck 2014; 36:1674-5. [PMID: 24954499 DOI: 10.1002/hed.23811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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10
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Final results of a phase II single-institutional trial with hyperfractionated radiation therapy (HFX) and four-weekly continuous cisplatin in locally advanced head and neck carcinoma. Clin Transl Oncol 2013; 16:555-60. [PMID: 24203760 DOI: 10.1007/s12094-013-1118-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To evaluate the efficacy and toxicity of hyperfractionated radiation therapy and continuous infusion of cisplatin on weeks 1 and 5 in locally advanced head and neck carcinoma. METHODS There were 53 patients: 3 (5.7 %) T2 patients, 31 T3 patients (58.4 %), and 19 T4 patients (35.8 %). Forty-one patients (77.4 %) were N-positive. According to the AJCC, 40 (75.4 %) patients had stage IV and the rest stage III. Treatment consisted of hyperfractionated radiation therapy, 120 cGy bid to a dose of 76.8-81.6 Gy, and cisplatin 20 mg/m(2)/day administered by continuous infusion over 120 h during days 1-5 and 21-25 of radiation therapy. RESULTS Tumor response and toxicity There were 40 (75.5 %) complete responses, 6 partial responses (11.3 %), and 5 (9.4 %) non-responses or progression. Two patients were non-evaluable for response due to toxic death. All patients had some acute toxicity grade, the most frequent being mucositis (grade 3-4 in 33 patients) and epithelitis (grade 3-4 in 30 patients). Regarding late toxicity, only 2/24 long-term survivors had tracheostomy, and none of them needed enteral nutrition. Survival and local control With a median follow-up of 66 months, the 5-year overall survival rate for all the series was 49.1 % (95 % CI 58.9-39.3 %) with a median survival duration of 32.83 months. Five-year local control was 68.4 % (95 % CI 81.3-55.5 %). CONCLUSIONS Hyperfractionated radiation therapy and continuous infusion of cisplatin during weeks 1 and 5 are an active treatment in patients with LAHNC. Nevertheless, new strategies are necessary to increase the local control rates and reduce the incidence of distant metastasis and second tumors.
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Goenka A, Morris LGT, Rao SS, Wolden SL, Wong RJ, Kraus DH, Ohri N, Setton J, Lok BH, Riaz N, Mychalczak BR, Schoder H, Ganly I, Shah JP, Pfister DG, Zelefsky MJ, Lee NY. Long-term regional control in the observed neck following definitive chemoradiation for node-positive oropharyngeal squamous cell cancer. Int J Cancer 2013; 133:1214-21. [PMID: 23436584 DOI: 10.1002/ijc.28120] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/09/2013] [Indexed: 12/16/2022]
Abstract
Traditionally, patients treated with chemoradiotherapy for node-positive oropharyngeal squamous cell carcinoma (N+ OPSCC) have undergone a planned neck dissection (ND) after treatment. Recently, negative post-treatment positron-emission tomography (PET)/computed tomography (CT) imaging has been found to have a high negative predictive value for the presence of residual disease in the neck. Here, we present the first comprehensive analysis of a large, uniform cohort of N+ OPSCC patients achieving a PET/CT-based complete response (CR) after chemoradiotherapy, and undergoing observation, rather than ND. From 2002 to 2009, 302 patients with N+ OPSCC treated with 70 Gy intensity-modulated radiation therapy and concurrent chemotherapy underwent post-treatment clinical assessment including PET/CT. CR was defined as no evidence of disease on clinical examination and post-treatment PET/CT. ND was reserved for patients with <CR on either PET/CT, clinical examination, or other imaging. 260 patients (86.1%) had clinical and radiographic CRs, and underwent neck observation (rate of regional control, 97.7%; 5-year overall survival, 79.8%). The four observed patients experiencing neck recurrence had initial staging of N1 (n = 2), N2b (n = 1), and N2c (n = 1). Three of four were successfully surgically salvaged. There was no association between N stage and rate of neck recurrence (p = 0.74). 52 and 25% of patients undergoing ND had viable tumor in the neck after positive and negative PET/CT, respectively. We conclude that patients achieving CRs after chemoradiation, based on clinical and PET/CT assessment, have a high probability of regional control, with a 2.3% regional failure rate, and may be safely observed without planned ND.
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Affiliation(s)
- Anuj Goenka
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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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]
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13
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The contribution of neck dissection for residual neck disease after chemoradiotherapy in advanced oropharyngeal and hypopharyngeal squamous cell carcinoma patients. Int J Clin Oncol 2012; 18:578-84. [PMID: 22588781 DOI: 10.1007/s10147-012-0419-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Planned neck dissection after chemoradiotherapy (CRT) has remained controversial in advanced oro- and hypopharyngeal squamous cell carcinoma (OHSCC) patients. We evaluated the survival contribution of neck dissection (ND) in OHSCC patients with residual nodal disease following CRT. METHODS We retrospectively evaluated 84 OHSCC patients with N2-3 disease treated at Aichi Cancer Center Hospital between 1995 and 2006. ND after CRT was performed for residual neck disease in 36 patients, but not in 48 patients to achieve a complete response. These two groups were analyzed in terms of both overall survival (OS) and regional control (RC), and surgical complications were evaluated. RESULTS The 5-year OS was 76.7 % [95 % confidence interval (CI) 58.8-87.6] for the ND group and 73.9 % (58.6-84.3) for the non-ND group (P = 0.883). The 5-year RC was 91.6 % (76.1-97.2) for the ND group and 81.1 % (65.4-90.2) for the non-ND group (P = 0.252). Stratified by primary tumor site, the 5-year RC was 96.3 % (76.5-99.5) for the ND group, and 78.6 % (58.0-89.9) for the non-ND group (P = 0.072) in oropharyngeal squamous cell carcinoma patients, and 77.8 % (36.5-93.9) for the ND group and 85.9 % (54.0-96.3) for the non-ND group (P = 0.541) in hypopharyngeal squamous cell carcinoma patients. In addition, the complications after ND were tolerable. CONCLUSIONS We demonstrated that ND was feasible, safe, and correlated with clinical outcomes in OHSCC patients with residual nodal disease after CRT.
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Thariat J, Ang KK, Allen PK, Ahamad A, Williams MD, Myers JN, El-Naggar AK, Ginsberg LE, Rosenthal DI, Glisson BS, Morrison WH, Weber RS, Garden AS. Prediction of neck dissection requirement after definitive radiotherapy for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2012; 82:e367-74. [PMID: 22284033 PMCID: PMC4124997 DOI: 10.1016/j.ijrobp.2011.03.062] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND This analysis was undertaken to assess the need for planned neck dissection in patients with a complete response (CR) of involved nodes after irradiation and to determine the benefit of a neck dissection in those with less than CR by tumor site. METHODS Our cohort included 880 patients with T1-4, N1-3M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who received treatment between 1994 and 2004. Survival curves were calculated by the Kaplan-Meier Method, comparisons of rates with the log-rank test and prognostic factors by Cox's proportional hazard model. RESULTS Nodal CR occurred in 377 (43%) patients, of whom 365 patients did not undergo nodal dissection. The 5-year actuarial regional control rate of patients with CR was 92%. Two hundred sixty-eight of the remaining patients (53%) underwent neck dissections. The 5-year actuarial regional control rate for patients without a CR was 84%. Those who had a neck dissection fared better with 5-year actuarial regional control rates of 90% and 76% for those operated and those not operated (p < 0.001). Variables associated with poorer regional control rates included higher T and N stage, non-oropharynx cancers, non-CR, both clinical and pathological. CONCLUSIONS With 92% 5-year neck control rate without neck dissection after CR, there is little justification for systematic neck dissection. The addition of a neck dissection resulted in higher neck control after partial response though patients with viable tumor on pathology specimens had poorer outcomes. The identification of that subgroup that benefits from additional treatment remains a challenge.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
- Department of Radiation Oncology/IBDC CNRS UMR 6543. Cancer Center Antoine-Lacassagne. University Nice Sophia-Antipolis. 33 Av. Valombrose. 06189 - NICE Cedex 2 (FRANCE)
| | - K. Kian Ang
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Pamela K. Allen
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Anesa Ahamad
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Michelle D. Williams
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Jeffrey N. Myers
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
- Department of Cancer Biology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Adel K. El-Naggar
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Lawrence E. Ginsberg
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - David I. Rosenthal
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Bonnie S. Glisson
- Department of Thoracic/Head and Neck Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - William H. Morrison
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Randal S. Weber
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
| | - Adam S. Garden
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030, Texas
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Jang NY, Lee KW, Ahn SH, Kim JS, Kim IA. Neck control after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancers. BMC Cancer 2012; 12:59. [PMID: 22313843 PMCID: PMC3305564 DOI: 10.1186/1471-2407-12-59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/07/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate neck control outcomes after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancer. METHODS We retrospectively reviewed medical records of fifty patients with node-positive head and neck cancer who received definitive radiochemotherapy. Twelve patients subsequently underwent neck dissection for suspicious recurrent or persistent disease. A median dose of 70 Gy (range 60-70.6) was delivered to involved nodes. Response evaluation was performed at a median of 5 weeks after completion of radiotherapy. RESULTS Neck failure was observed in 11 patients and the 3-year regional control (RC) rate was 77.1%. Neck dissection was performed in 10 of the 11 patients; seven of these cases were successfully salvaged, and the ultimate rate of neck control was 92%. The remaining two patients who received neck dissection had negative pathologic results. On univariate analysis, initial nodal size > 2 cm, a less-than-complete response at the primary site, post-radiotherapy nodal size > 1.5 cm, and post-radiotherapy nodal necrosis were associated with RC. On multivariate analysis, less-than-complete primary site response and post-radiotherapy nodal necrosis were identified as independent prognostic factors for RC. CONCLUSIONS The neck failure rate after definitive radiochemotherapy without planned neck dissection was 22%. Two-thirds of these were successfully salvaged with neck dissection and the ultimate neck control rate was 92%. Our results suggest that planned neck dissection might not be necessary in patients with complete response of primary site, no evidence of residual lesion > 1.5 cm, or no necrotic lymph nodes at the 1-2 months follow-up evaluation after radiotherapy.
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Affiliation(s)
- Na Young Jang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 300 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea
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Clavel S, Charron MP, Bélair M, Delouya G, Fortin B, Després P, Soulières D, Filion É, Guertin L, Nguyen-Tan PF. The Role of Computed Tomography in the Management of the Neck After Chemoradiotherapy in Patients With Head-and-Neck Cancer. Int J Radiat Oncol Biol Phys 2012; 82:567-73. [DOI: 10.1016/j.ijrobp.2010.11.066] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 11/06/2010] [Accepted: 11/12/2010] [Indexed: 11/15/2022]
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Khafif A, Ferlito A, Takes RP, Thomas Robbins K. Is it necessary to perform radical neck dissection as a salvage procedure for persistent or recurrent neck disease after chemoradiotherapy in patients with nasopharyngeal cancer? Eur Arch Otorhinolaryngol 2010; 267:997-9. [PMID: 20352240 PMCID: PMC2874044 DOI: 10.1007/s00405-010-1235-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Avi Khafif
- Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Alfio Ferlito
- ENT Clinic, Department of Surgical Sciences, University of Udine, Azienda Ospedaliero-Universitaria, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
| | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - K. Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL USA
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Haigentz M, Silver CE, Corry J, Genden EM, Takes RP, Rinaldo A, Ferlito A. Current trends in initial management of oropharyngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1845-55. [DOI: 10.1007/s00405-009-1109-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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