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Song JM, Mo N, Lv YQ, Huang LL, Wen YJ, Liu T, Li ZR, Wang RS, Zhang TT. Effects of concurrent chemoradiotherapy with or without Endostar on the regression of retropharyngeal lymph node and prognosis of patients with locally advanced nasopharyngeal carcinoma: a retrospective study. J Cancer Res Clin Oncol 2024; 150:232. [PMID: 38703186 PMCID: PMC11069474 DOI: 10.1007/s00432-024-05762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE To investigate the effect of combining Endostar with concurrent chemoradiotherapy (ECCRT) compared to concurrent chemoradiotherapy (CCRT) on the regression rate of retropharyngeal lymph nodes (RLNs) and the relationship between regression rate of RLNs and prognosis of patients with locally advanced nasopharyngeal carcinoma (LANPC). METHODS A total of 122 LANPC patients with RLNs metastasis were included. Metastatic RLNs were delineated both before and after treatment slice by slice on the magnetic resonance images cross-section. The regression rate of RLNs, adverse effects (AE) were evaluated. The median regression rate of RLNs was taken as the cut-off value, and the patients were furtherly divided into high regression rate (HRR) group and low regression rate (LRR) group, then survival times were evaluated. RESULTS The median regression rates of RLNs in the ECCRT and CCRT groups were 81% and 50%, respectively (P < 0.001). There was no statistically significant difference in the incidence of grade 3/4 AEs between the two groups, except for oral mucositis (ECCRT 26.23% vs. CCRT 44.26%, P = 0.037). The 3-year overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and locoregional failure-free survival (LRFFS) rates in the HRR and LRR groups were 85.48% and 86.67% (P = 0.983), 80.65% and 68.33% (P = 0.037), 83.87% and 85% (P = 0.704), 93.55% and 81.67% (P = 0.033), respectively. CONCLUSIONS Patients in the ECCRT group had higher regression rates of RLNs and lower incidence of severe oral mucositis. Furthermore, patients in the HRR group had a better 3-year PFS and LRFFS rate than those in the LRR group.
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Affiliation(s)
- Jun-Mei Song
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Oncology Department, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Ning Mo
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Yu-Qing Lv
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Lu-Lu Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Ya-Jing Wen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ting Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Zhi-Ru Li
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Ren-Sheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Ting-Ting Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Xue K, Liu J, Liu Q, Zhang HK, Liu Q, Li J, Jiang XW, Zhao KQ, Gu Y, Song XL, Sun XC, Yu HM. Anatomical studies and early results on endoscopic transoral medial pterygomandibular fold approach to salvage retropharyngeal lymphadenectomy in nasopharyngeal carcinoma. J Laryngol Otol 2024; 138:540-547. [PMID: 38348656 DOI: 10.1017/s0022215123002013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Retropharyngeal lymphadenectomy is challenging. This study investigated a minimally invasive approach to salvage retropharyngeal lymphadenectomy in patients with nasopharyngeal carcinoma. METHODS An anatomical study of four fresh cadaveric heads was conducted to demonstrate the relevant details of retropharyngeal lymphadenectomy using the endoscopic transoral medial pterygomandibular fold approach. Six patients with nasopharyngeal cancer with retropharyngeal lymph node recurrence, who underwent retropharyngeal lymphadenectomy with the endoscopic transoral medial pterygomandibular fold technique at the Eye and ENT Hospital of Fudan University from July to December 2021, were included in this study. RESULTS The anatomical study demonstrated that the endoscopic transoral medial pterygomandibular fold approach offers a short path and minimally invasive approach to the retropharyngeal space. The surgical procedure was well tolerated by all patients, with no significant post-operative complications. CONCLUSION The endoscopic transoral medial pterygomandibular fold approach is safe and efficient for retropharyngeal lymphadenectomy.
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Affiliation(s)
- Kai Xue
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Juan Liu
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Qiang Liu
- Department of Radiology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Huan-Kang Zhang
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Quan Liu
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Jing Li
- Department of Otolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
| | - Xiao-Wen Jiang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Hospital (Nanshan Hospital), Shenzhen City, PR China
| | - Ke-Qing Zhao
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Ye Gu
- Department of Neurosurgery, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Xiao-Le Song
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Xi-Cai Sun
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
| | - Hong-Meng Yu
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
- Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor (2018RU003), Chinese Academy of Medical Sciences, Shanghai, PR China
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Zhu Y, Luo C, Zhou S, Li H, Liu L, Kou KI, Lei F, Zhang G, Cao D, Liang Z. Optimal Size Threshold for MRI-Detected Retropharyngeal Lymph Nodes to Predict Outcomes in Nasopharyngeal Carcinoma: A Two-Center Study. AJR Am J Roentgenol 2024; 222:e2329984. [PMID: 37753859 DOI: 10.2214/ajr.23.29984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND. Retropharyngeal lymph node (RLN) metastases have profound prognostic implications in patients with nasopharyngeal carcinoma (NPC). However, the AJCC staging system does not specify a size threshold for determining RLN involvement, resulting in inconsistent thresholds in practice. OBJECTIVE. The purpose of this article was to determine the optimal size threshold for determining the presence of metastatic RLNs on MRI in patients with NPC, in terms of outcome predictions. METHODS. This retrospective study included 1752 patients (median age, 46 years; 1297 men, 455 women) with NPC treated by intensity-modulated radiotherapy (RT) from January 2010 to March 2014 from two hospitals; 438 patients underwent MRI 3-4 months after treatment. Two radiologists measured the minimal axial diameter (MAD) of the largest RLN for each patient using a consensus process. A third radiologist measured MAD in 260 randomly selected patients to assess interobserver agreement. Initial ROC and restricted cubic spline (RCS) analyses were used to derive an optimal MAD threshold for predicting progression-free survival (PFS). The threshold's predictive utility was assessed in multivariable Cox regression analyses, controlling for standard clinical predictors. The threshold's utility for predicting PFS and overall survival (OS) was compared with a 5-mm threshold using Kaplan-Meier curves and log-rank tests. RESULTS. The intraclass correlation coefficient for MAD was 0.943. ROC and RCS analyses yielded an optimal threshold of 6 mm. In multivariable analyses, MAD of 6 mm and greater independently predicted PFS in all patients (HR = 1.35, p = .02), patients with N0 or N1 disease (HR = 1.80, p = .008), and patients who underwent posttreatment MRI (HR = 1.68, p = .04). In patients with N1 disease without cervical lymph node involvement, 5-year PFS was worse for MAD greater than or equal to 6 mm than for MAD that was greater than or equal to 5 mm but less than 6 mm (77.2% vs 89.7%, p = .03). OS was significantly different in patients with stage I and stage II disease defined using a 6-mm threshold (p = .04), but not using a 5-mm threshold (p = .09). The 5-year PFS rate was associated with a post-RT MAD of 6 mm and greater (HR = 1.68, p = .04) but not a post-RT MAD greater than or equal to 5 mm (HR = 1.09, p = .71). CONCLUSION. The findings support a threshold MAD of 6 mm for determining RLN involvement in patients with NPC. CLINICAL IMPACT. Future AJCC staging updates should consider incorporation of the 6-mm threshold for N-category and tumor-stage determinations.
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Affiliation(s)
- Yuliang Zhu
- Nasopharyngeal Head and Neck Tumor Radiotherapy Department, Zhongshan City People's Hospital, Zhongshan, P. R. China
| | - Chao Luo
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong 510060, P. R. China
| | - Shumin Zhou
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong 510060, P. R. China
| | - Haojiang Li
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong 510060, P. R. China
| | - Lizhi Liu
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong 510060, P. R. China
| | - Kit Ian Kou
- Department of Mathematics, Faculty of Science and Technology, University of Macau, Macao Special Administrative Region, P. R. China
| | - Feng Lei
- Nasopharyngeal Head and Neck Tumor Radiotherapy Department, Zhongshan City People's Hospital, Zhongshan, P. R. China
| | - Guoyi Zhang
- Department of Radiation Oncology, Cancer Center, the First People's Hospital of Foshan, Foshan, P. R. China
| | - Di Cao
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong 510060, P. R. China
| | - Zhiying Liang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong 510060, P. R. China
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Ghedia R, Hariri A, Lee YK, Dragan A, Paleri V, Ap Dafydd D. Saline-aided ultrasound-guided transoral biopsy of retropharyngeal nodes in head and neck cancer: A feasibility study of five patients. Head Neck 2023; 45:2355-2362. [PMID: 37462067 DOI: 10.1002/hed.27453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/21/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the feasibility of the novel technique of intra-cavitary saline-aided ultrasound (US) guided transoral biopsy or excision of retropharyngeal nodes. METHODS We followed the IDEAL 2a framework to develop this technique. Procedures were performed between July 2020 and July 2022 at a tertiary head and neck center. RESULTS Five patients in total underwent an ultrasound-guided biopsy of a retropharyngeal node. They underwent seven procedures between them: three transoral robotic surgery (TORS) procedures, three fine needle aspirations (FNA) and/or core biopsy procedures, and one US assessment under general anesthetic. The six patients with histology taken (three TORS and three FNA/core biopsies) all had diagnostically adequate samples enabling appropriate treatment planning. There were no significant complications from the procedure. CONCLUSION Saline-aided US-guided biopsy of a retropharyngeal node is a safe and useful tool enabling accurate tissue sampling and tumor excision and ongoing appropriate treatment planning.
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Affiliation(s)
- Reshma Ghedia
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Ahmad Hariri
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Ying Ki Lee
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Alina Dragan
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Vinidh Paleri
- Head and Neck Department, Royal Marsden Hospital, London, UK
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Baba A, Kurokawa R, Kurokawa M, Rivera-de Choudens R, Srinivasan A. Performance of axial diameter on MR imaging for identification of retropharyngeal lymph node metastases in head and neck cancer: a systematic review and meta-analysis. Neuroradiology 2023; 65:1363-1369. [PMID: 37522935 DOI: 10.1007/s00234-023-03205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To summarize previous studies' data and to calculate the diagnostic performance of minimum axial diameter (MIAD) and maximum axial diameter (MAAD) on each of the cutoff values in retropharyngeal lymph node (RPLNs) metastases in head and neck cancer. METHODS MEDLINE, Scopus, and Embase databases were searched for systematic review. Meta-analysis was performed to summarize estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) and generate summary recipient operator characteristic (sROC). RESULTS The review identified 5 studies with a total of 634 patients (971 lesions) that were eligible for the meta-analysis. The estimated sensitivity, specificity, and DOR at MIAD 5 mm cutoff and MIAD 6 mm cutoff were 89.8% and 74.3%, 82.7% and 92.7%, and 39.1 and 57.9, respectively. The estimated sensitivity, specificity, and DOR at MAAD 7 mm cutoff and MAAD 8 mm cutoff were 90.3% and 84.7%, 62.7% and 79.9%, and 17.8 and 21.7, respectively. The AUCs of sROC at MIAD 5 mm cutoff and MIAD 6 mm cutoff were 0.922 and 0.943. At MAAD 7 mm and MAAD 8 mm, they were 0.840 and 0.888. CONCLUSION The diagnostic performance of the MIAD 6 mm cutoff in RPLN metastases from head and neck cancer was 2% higher than the MIAD 5 mm cutoff. The diagnostic performance of MIAD was higher than that of MAAD.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Roberto Rivera-de Choudens
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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Toya R, Matsuyama T, Saito T, Fukugawa Y, Watakabe T, Shiraishi S, Murakami D, Orita Y, Hirai T, Oya N. Prevalence and risk factors for retropharyngeal and retro-styloid lymph node metastasis in hypopharyngeal carcinoma. Radiat Oncol 2023; 18:134. [PMID: 37568173 PMCID: PMC10422770 DOI: 10.1186/s13014-023-02322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND We evaluated the prevalence and identified the risk factors for retropharyngeal and retro-styloid lymph node metastasis (LNM) in patients with hypopharyngeal carcinoma (HPC). This was achieved using a combination of magnetic resonance (MR) and [18 F]-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) images. METHODS Two board-certified radiation oncologists retrospectively reviewed pretreatment FDG-PET/CT images and contrast-enhanced thin-slice CT and MR images of 155 patients with HPC who underwent radiotherapy. Fisher's exact tests and logistic regression analyses were performed to assess the risk factors for LNM. RESULTS Retropharyngeal LNM (RPLNM) was confirmed in 20 (13%) patients. Posterior wall (PW) tumors (odds ratio [OR]: 4.128, 95% confidence interval [CI]: 1.339-12.727; p = 0.014) and bilateral or contralateral cervical LNM (OR: 11.577, 95% CI: 2.135-62.789; p = 0.005) were significantly correlated with RPLNM. The RPLNM was found in 9 (32%) of the 28 patients with PW tumors. Of these 9 patients, 2 (7%) had ipsilateral RPLNM, 3 (11%) had contralateral RPLNM, and 4 (14%) had bilateral RPLNM. The PW tumors were significantly associated with contralateral RPLNM (p < 0.001). Retro-styloid LNM (RSLNM) was confirmed in two (1%) patients, both of whom had ipsilateral RSLNM with lymph nodes (LNs) of ≥ 15 mm in the upper limit of ipsilateral level II. A significant association was found between LNs of ≥ 15 mm in the upper limit of ipsilateral level II and ipsilateral RSLNM (p = 0.001). CONCLUSIONS The RPLNM was identified in 13% of patients with HPC. The PW tumors and bilateral or contralateral cervical LNM were risk factors for RPLNM; particularly, PW tumors were a specific risk factor for contralateral RPLNM. Although the RSLNM was rare, LNs of ≥ 15 mm in the upper limit of ipsilateral level II were a risk factor for ipsilateral RSLNM.
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Affiliation(s)
- Ryo Toya
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshiyuki Fukugawa
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiro Watakabe
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Daizo Murakami
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Bruening J. Robotic Surgery in the Head and Neck: Presurgical Considerations and Post-treatment Appearance. Semin Roentgenol 2023; 58:374-383. [PMID: 37507177 DOI: 10.1053/j.ro.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Jennifer Bruening
- Department of Otolaryngology and Communication Sciences, Head and Neck Surgical Oncology and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, WI.
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Campagnoli M, Masnaghetti D, Rosa MS, Paganelli E, Garzaro M, Aluffi Valletti P. Parapharyngeal Metastasis of Papillary Carcinoma of Thyroid Gland: A Case Report and a Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13081426. [PMID: 37189526 DOI: 10.3390/diagnostics13081426] [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: 03/22/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Papillary carcinoma is the most frequently encountered differentiated thyroid carcinoma. Usually, metastasis occurs along lymphatic pathways in the central compartment and along the jugular chain. Nevertheless, lymph node metastasis in the parapharyngeal space (PS) is a rare but possible event. In fact, a lymphatic pathway has been identified that connects the upper pole of the thyroid and the PS. We describe the case of a 45-year-old man with a two-month history of a right neck mass. He underwent a complete diagnostic path that highlighted the presence of a parapharyngeal mass associated with the presence of a thyroid nodule suspected to be malignant. The patient underwent surgery (thyroidectomy and removal of the PS mass that was found to be a metastatic node of papillary thyroid carcinoma). The aim of this case is to underline the importance of detecting these kinds of lesions. Nodal metastasis in PS from thyroid cancer is a rare occurrence that is not easily detectable by a clinical examination until the metastasis reaches a considerable dimension. Computed tomography (CT) and magnetic resonance imaging (MRI) permit early identification, but unfortunately, these are not usually employed as a first-level imaging technique in patients with thyroid cancer. The treatment of choice is surgery with a transcervical approach that allows for better control of the disease and of the anatomical structures. Non-surgical treatments are usually reserved for patients with advanced disease, with satisfactory results.
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Affiliation(s)
| | | | - Maria Silvia Rosa
- ENT Department, University of Piemonte Orientale, 28100 Novara, Italy
| | - Edoardo Paganelli
- ENT Department, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy
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Zhao Y, Fang J, Zhong Q, Zhang L, Wang C, Zhang J, Chen J, Feng L, He S, Ma H, Hou L, Lian M, Shi Q, Shen X, Yang Y, Wang R. A combined microinvasive trans-submandibular and nasendoscopy surgical approach to dissect recurrent or radiotherapy-insensitive nasopharyngeal carcinoma. Front Oncol 2022; 12:939404. [PMID: 36059683 PMCID: PMC9428256 DOI: 10.3389/fonc.2022.939404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate a novel combined microinvasive trans-submandibular and nasendoscopy surgical approach for nasopharyngeal carcinoma involving the parapharyngeal space. Methods Seven patients diagnosed with nasopharyngeal carcinoma involving the parapharyngeal space between May 2018 and April 2021, two males and five females, aged 37–63 years.Six of the 7 patients underwent submental flap preparation and dissection of the lymph nodes in the upper neck and parapharyngeal space on the lesion side. The nasopharynx lesions and tumor margins were dissected under nasal endoscopy. The medial boundary of internal carotid artery separated by open cervical approach was used as the lateral boundary of the tumor to realize en bloc resection of the tumor. Results The patients were preoperatively diagnosed with T2~3N0M0 nasopharyngeal carcinoma, including mucoepidermoid carcinoma (n=2), papillary adenocarcinoma (n=1), and nonkeratinizing squamous cell carcinoma (n=4). The tumors were removed completely, and patients achieved primary healing of the incision. No recurrence and no serious complications were recorded during the 13–48 month follow-up. Conclusion Complete resection of the tumor was obtained in the 7 patients without recurrence and serious complications during the follow-up. The findings of this cohort study suggest that, patients with recurrent nasopharyngeal carcinoma after radiotherapy and radiotherapy-insensitive types of nasopharyngeal carcinoma, the combined microinvasive trans-submandibular and nasendoscopy surgical approach may be considered as an surgical options. The results of this study provide an additional option for surgical treatment of NPC in the clinic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ru Wang
- *Correspondence: Jugao Fang, ; Ru Wang,
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Tirelli G, Gardenal N, Zanelli E, Borsetto D, Phillips V, Marcuzzo AV, Fussey J, Polesel J, Boscolo-Rizzo P. Prevalence and prognostic impact of retropharyngeal lymph nodes metastases in oropharyngeal squamous cell carcinoma: Meta-analysis of published literature. Head Neck 2022; 44:2265-2276. [PMID: 35913029 PMCID: PMC9540534 DOI: 10.1002/hed.27166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to estimate the prevalence and prognostic impact of retropharyngeal lymph node metastases (RLNMs) in oropharyngeal squamous cell carcinoma (OPSCC). METHODS This meta-analysis was conducted according to PRISMA guidelines. INCLUSION CRITERIA studies with more than 20 patients reporting the prevalence or prognostic impact of RLNMs in OPSCC. Whenever available, data on HPV status and subsites were extracted. RESULTS Twenty-two articles were included. The overall prevalence of RLNMs in OPSCC was 13%, with no significant differences depending on HPV status. The highest prevalence was observed for posterior pharyngeal wall SCC (24%), followed by soft palate (17%), palatine tonsil (15%), and base of tongue (8%). RLNMs were associated with a significantly higher risk of death (HR:2.54;IC95%1.89-3.41) and progression (HR:2.44;IC95%1.80-3.30). CONCLUSIONS The prevalence of RLNMs in OPSCC was 13%, being higher in tumors of the posterior pharyngeal wall. RLNMs were associated with unfavorable outcomes.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Enrico Zanelli
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Daniele Borsetto
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Alberto Vito Marcuzzo
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Jonathan Fussey
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
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11
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Abdelrahman A, McGoldrick D, Aggarwal A, Idle MR, Praveen P, Martin T, Parmar S. Retropharyngeal lymph node metastasis in oral cancer. Systematic review and survival analysis. Br J Oral Maxillofac Surg 2022; 60:563-569. [PMID: 35337688 DOI: 10.1016/j.bjoms.2021.06.001] [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: 03/15/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Metastasis to retropharyngeal lymph nodes (RPLN) from oral squamous cell carcinoma is rare and associated with poor outcomes. The poor prognosis of RPLN is multifactorial and includes the clinicopathological aggressiveness of the primary disease and the late presentation. The aim of this systematic review is to assess the evidence on RPLN in patients diagnosed with oral squamous cell carcinoma (OSCC), the quality of the diagnostic modalities and the available treatment options. We aimed to analyse the overall survival of these patients diagnosed with RPLN. METHODS A systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The initial literature search generated 289 articles. A total of 11 papers satisfied our criteria. Eight papers provided enough data to perform survival analysis and 3 papers compared the diagnostic modalities used in the detection of RPLN. RESULTS A total of 73 OSCC patients diagnosed with RPLN metastasis were identified. The most common primary tumour subsites included the tongue (20), buccal mucosa (15) and gingiva (11). The cumulative 5-year OS rate was 17.8% while the 2-year overall survival was 35.9%. CONCLUSION The presence of nodal metastasis is an independent prognostic factor in head and neck cancer. In this study, RPLN metastasis had a poorer prognosis (5 years overall survival is 17.8%) when compared to the survival rate of oral cancer without RPLN metastasis (5 years overall survival is 40%). There was no statistically significant difference between the overall survival in primary RPLN metastasis and recurrent RPLN disease.
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Affiliation(s)
- A Abdelrahman
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - D McGoldrick
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - A Aggarwal
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - M R Idle
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - P Praveen
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - T Martin
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - S Parmar
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
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13
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孙 希, 薛 凯, 刘 强, 张 焕, 刘 全, 蒋 晓, 赵 可, 顾 晔, 宋 小, 余 洪. [Endoscopic transoral retropharyngeal lymphadenectomy]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:81-86. [PMID: 35172541 PMCID: PMC10128319 DOI: 10.13201/j.issn.2096-7993.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Indexed: 06/14/2023]
Abstract
Objective:The aim of this study is to explore the anatomy and surgical approach of retropharyngeal lymphadenectomy via endoscopic transoral approach. Methods:The retropharyngeal spaces were studied with three fresh frozen cadaver head (6 sides) in the anatomical laboratory of Eye, Ear, Nose and Throat Hospital of Fudan University through endoscopic transoral approach. The superior pharyngeal constrictor muscle, medial pterygoid muscle, tendon of tensor veli palatini muscle, fat of prestyloid space, ascending palatine artery and its branches, styloglossus, stylopharyngeus, stylohyoideus, external carotid artery, levator veli palatini, carotid sheath, ascending pharyngeal artery and longus capitis muscle were revealed in order. The above-mentioned structures were photographed with a 0° Karl Storz nasal endoscope and adjacent relationships were recorded. A case of metastatic retropharyngeal lymphadenopathy was reviewed and the surgical methods and techniques of retropharyngeal lymphadenectomy via endoscopic transoral approach were introduced in detail. Results:The retropharyngeal space and related anatomical structures were exposed through endoscopic transoral approach in all specimens. The styloglossus, stylopharyngius and levator veli palatini are the markers of locating the internal carotid artery. The superior pharyngeal constrictor muscle, medial pterygoid muscle, styloid muscle group, longus capitis muscle and carotid sheath are the markers that can be used to locate the retropharyngeal lymph nodes. Ascending palatine artery, ascending pharyngeal artery and internal carotid artery are the main arteries involved in retropharyngeal lymphadenectomy via endoscopic transoral approach. Conclusion:Endoscopic transoral approach is a new surgical technique to perform retropharyngeal lymphadenectomy safely and completely.
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Affiliation(s)
- 希才 孙
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 凯 薛
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 强 刘
- 复旦大学附属眼耳鼻喉科医院放射科Department of Radiology, Eye & ENT Hospital, Fudan University
| | - 焕康 张
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 全 刘
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 晓文 蒋
- 华中科技大学协和深圳医院(南山人民医院)耳鼻咽喉科Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital[Nanshan Hospital]
| | - 可庆 赵
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 晔 顾
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 小乐 宋
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - 洪猛 余
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科(上海,200031)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- 中国医学科学院内镜下鼻颅底肿瘤外科治疗技术创新单元(2018RU003)Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor[2018RU003], Chinese Academy of Medical Sciences
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14
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Kosugi Y, Suzuki M, Fujimaki M, Ohba S, Matsumoto F, Muramoto Y, Kawamoto T, Oshima M, Shikama N, Sasai K. Radiologic criteria of retropharyngeal lymph node metastasis in maxillary sinus cancer. Radiat Oncol 2021; 16:190. [PMID: 34565434 PMCID: PMC8474827 DOI: 10.1186/s13014-021-01917-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the most appropriate radiologic criteria of metastatic retropharyngeal lymph nodes (RLNs) in patients with maxillary sinus cancer (MSC). Materials and methods We retrospectively evaluated 16 consecutive patients who underwent magnetic resonance imaging (MRI) before and after the treatment of locally advanced squamous cell carcinoma of the maxillary sinus. The minimal and maximal diameters of all RLNS were recorded. RLNs were classified as metastatic on the basis of the MRI follow-up (f/u). RLNs were considered non-metastatic if stable disease continued until the final MRI f/u and metastatic in cases with different evaluations (complete response, partial response, progressive disease) determined using Response Evaluation Criteria in Solid Tumours (RECIST) ver. 1.1. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to assess the accuracy of various criteria in the diagnosis of metastatic RLNs. Results Of the 34 RLNs in 16 cases observed on pretreatment MRI, 7 were classified as metastatic RLNs and 27 as non-metastatic RLNs. Using the radiologic criteria, metastatic RLNs tended to be diagnosed more accurately with the minimal axial diameter than with the maximal axial diameter (AUC; 0.97 vs. 0.73, p = 0.06). The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 5 mm or larger, with an accuracy of 94.1% (32 of 34). Conclusions The most appropriate radiologic criterion of metastatic RLNs in MSC is a minimal axial diameter of 5 mm or longer.
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Affiliation(s)
- Yasuo Kosugi
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | | | - Mitsuhisa Fujimaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University, Tokyo, Japan
| | - Shinichi Ohba
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University, Tokyo, Japan
| | - Yoichi Muramoto
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masaki Oshima
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Bunch PM, Patwa HS, Hughes RT, Porosnicu M, Waltonen JD. Patient Selection for Transoral Robotic Surgery (TORS) in Oropharyngeal Squamous Cell Carcinoma: What the Surgeon Wants to Know. Top Magn Reson Imaging 2021; 30:117-130. [PMID: 33828063 DOI: 10.1097/rmr.0000000000000269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Transoral robotic surgery (TORS) is an excellent treatment strategy for well-selected patients with oropharyngeal squamous cell carcinoma. Potential benefits of TORS are greatest among patients for whom surgical resection will reduce or eliminate the need for adjuvant therapy. Proper patient selection largely depends on imaging, which is used to determine tumor resectability, to inform expected morbidity and functional outcome, to assess the potential need for adjuvant therapy, to evaluate for vascular or other anatomic contraindications, and to gauge adequacy of transoral access to the tumor. This article provides the radiologist with a practical and accessible approach to interpreting preoperative imaging among patients with oropharyngeal cancer, emphasizing what the surgeon wants to know to inform the determination of whether the patient is a TORS candidate and why this information is important. By accurately reporting this information, the radiologist facilitates the multidisciplinary care team's selection of a treatment regimen optimized for the circumstances of the individual patient.
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Affiliation(s)
- Paul M Bunch
- Department of Radiology Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
| | - Hafiz S Patwa
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston Salem, NC
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC
| | - Mercedes Porosnicu
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC
| | - Joshua D Waltonen
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston Salem, NC
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16
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Tu DG, Chen HY, Yao WJ, Hung YS, Chang YK, Chang CH, Wang YW. Verification of the Efficacy of New Diagnostic Criteria for Retropharyngeal Nodes in a Cohort of Nasopharyngeal Carcinoma Patients. Int J Med Sci 2021; 18:3463-3469. [PMID: 34522172 PMCID: PMC8436115 DOI: 10.7150/ijms.58375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/02/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose: A multistage approach to diagnose lateral retropharyngeal nodes (LRPNs) of nasopharyngeal carcinoma (NPC) had been proposed and warranted for validation. Methods: Between 2012 and 2017, the patients with newly diagnosed NPC were enrolled. The responsive nodes or those that progressed during follow-up were positive. The criteria for the multistage approach delimited LRPNs with a minimal axial diameter (MIAD) ≥ 6.1 mm were assessed as positive and if the mean standard uptake value ≥ 2.6, or if the maximal coronal diameter ≥ 25 mm and maximal axial diameter ≥ 8 mm with nodes MIAD < 6.1 mm were also considered as positive. The outcomes were compared with the MIAD cutoff value ≥ 6 mm (traditional method). A chi-squared test was used to compare two areas under the curve of the receiver operating characteristic curves. Results: A total of 67 eligible NPC cases and 155 LRPNs (72 positive and 83 negative) were analyzed. The accuracy, specificity, and sensitivity of the traditional method were 0.91, 0.93, and 0.89, respectively. The values for the multistage approach all reached 0.94. The area under the curve was significantly greater for the multistage approach compared with the traditional method (p = 0.023). Conclusion: The results support the advantage of the multistage approach.
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Affiliation(s)
- Dom-Gene Tu
- Department of Nuclear Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Hsuan-Yu Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Wei-Jen Yao
- Department of Nuclear Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yu-Sheng Hung
- Division of Nuclear Medicine, Department of Medical Imaging, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Yu-Kang Chang
- Department of Medical Imaging Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chih-Han Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Wang
- Department of Radiation Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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17
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Iyizoba-Ebozue Z, Murray LJ, Ramasamy S, Sen M, Murray P, Cardale K, Dyker K, Prestwich RJD. Radiotherapy for Oropharyngeal Carcinoma With an Uninvolved Contralateral Neck: The Safety of Omission of Contralateral High Level II and Retropharyngeal Lymph Nodes From Elective Target Volumes. Clin Oncol (R Coll Radiol) 2020; 33:331-339. [PMID: 33358282 DOI: 10.1016/j.clon.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/05/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
AIMS To analyse outcomes and patterns of failure in patients with oropharyngeal carcinoma (OPC) treated with definitive volumetric modulated arc therapy with omission of contralateral high level II lymph nodes (HLII) and retropharyngeal lymph nodes (RPLN) in the contralateral uninvolved neck. MATERIALS AND METHODS Patients with OPC treated between January 2016 and July 2019 were retrospectively identified. In the absence of contralateral neck disease, institutional protocols allowed omission of contralateral HLII and contralateral RPLN in the additional absence of ipsilateral RPLN, soft palate/posterior pharyngeal wall primary. RESULTS In total, 238 patients with OPC and an uninvolved contralateral neck received definitive (chemo)radiotherapy with bilateral neck treatment. The median follow-up was 30.6 months. Two-year local control, regional control and overall survival were 91.0, 91.6 and 86.5%, respectively. Contralateral HLII were omitted in 159/238 (66.8%) patients; this included 106 patients in whom the primary tumour was at/crossed the midline. The contralateral RPLN region was omitted from elective target volumes for 175/238 (73.5%); this included 114 patients with a primary tumour at/crossed the midline. The mean contralateral parotid dose when contralateral HLII and RPLN were both omitted was 24.4 Gy, compared with 28.3 Gy without HLII/RPLN omission (P < 0.001). Regional progression occurred in 18/238 (7.6%) patients, all involving the ipsilateral neck with one bilateral. There were no recurrences in the contralateral HLII or RPLN regions. CONCLUSION In patients with OPC and an uninvolved contralateral neck receiving bilateral (chemo)radiotherapy, the omission of contralateral RPLN and HLII from elective target volumes was safe and could lead to reduced contralateral parotid doses.
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Affiliation(s)
| | - L J Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - S Ramasamy
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - M Sen
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - P Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - K Cardale
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - K Dyker
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - R J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.
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18
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Sandler ML, Xing MH, Levy JC, Chai RL, Khorsandi AS, Gonzalez-Velazquez C, Urken ML. Metastatic thyroid carcinoma to the parapharyngeal and retropharyngeal spaces: Systematic review with seven newly reported cases describing an uncommon presentation of a common disease. Head Neck 2020; 43:1331-1344. [PMID: 33295689 DOI: 10.1002/hed.26572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Metastatic thyroid carcinoma to retropharyngeal and parapharyngeal (RP/PP) lymph nodes is rare. Literature suggests previous lateral neck dissection (LND) may alter patterns of lymphatic drainage in the neck, predisposing to these less common sites of spread. METHODS PRISMA-guided systematic search for all published cases detailing RP/PP metastases of well-differentiated thyroid carcinoma from 1970 to 2019. RESULTS Seventy articles were identified and 44 were included, along with seven cases treated at our institution, totaling 239 cases. Cases represented both retropharyngeal (60.7%) and parapharyngeal (39.3%) metastases identified in the initial (27.6%) and recurrent (72.4%) setting. CONCLUSION RP/PP metastases generally present in the recurrent setting. RP/PP metastases often represent high-risk disease, and surgical treatment is recommended.
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Affiliation(s)
- Mykayla L Sandler
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Juliana C Levy
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Camilo Gonzalez-Velazquez
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Division of Endocrinology, Internal Medicine Department, Dr. Jose E. González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Kim JH, Choi KY, Lee SH, Lee DJ, Park BJ, Yoon DY, Rho YS. The value of CT, MRI, and PET-CT in detecting retropharyngeal lymph node metastasis of head and neck squamous cell carcinoma. BMC Med Imaging 2020; 20:88. [PMID: 32727384 PMCID: PMC7391504 DOI: 10.1186/s12880-020-00487-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 08/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnostic accuracies of the imaging studies should be clearly acknowledged in managing head and neck cancer patients; however, the accuracies of preoperative imaging studies in detecting retropharyngeal lymph node (RPLN) metastasis are still not clarified. This study was to evaluate diagnostic accuracies of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) in detecting RPLN metastasis of head and neck squamous cell carcinomas. METHODS For 123 patients who had performed RPLN dissection during the surgery of their squamous cell carcinoma of the head and neck, preoperative CT, MRI, and/or PET-CT were reviewed for RPLN metastasis in a blinded fashion by one experienced radiologist. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of each imaging modality were assessed, by comparing with the histopathologic findings of the resected RPLNs that served as the standard of reference. RESULTS RPLNs were pathologically positive for metastasis in 43 of the 123 patients (35%). Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in detecting metastasis to RPLN were 65, 94, 85, 83, and 84% for CT; 74, 94, 87, 87 and 87% for MRI; 83, 93, 89, 89 and 89% for PET-CT, respectively. When all the three imaging modalities were considered together (n = 74), they offered sensitivity of 90%, specificity of 91%, positive predictive value of 87%, negative predictive value of 93%, and accuracy of 91%. CONCLUSIONS The preoperative imaging studies offered relatively high specificity rates, but rather low sensitivity rates. The three imaging modalities altogether increased diagnostic accuracies, which highlights the potential of the three studies when used altogether can minimize missed diagnoses of RPLN metastasis.
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Affiliation(s)
- Jin Hwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Daerim-1dong, Yeongdeungpo-gu, Seoul, 150-950, South Korea.
| | - Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Daerim-1dong, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Sang-Hyo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Daerim-1dong, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Dong Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Daerim-1dong, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Bum Jung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Daerim-1dong, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Dae Young Yoon
- Department of Radiology, Hallym University College of Medicine, Seoul, South Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Daerim-1dong, Yeongdeungpo-gu, Seoul, 150-950, South Korea
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Chen J, Luo J, He X, Zhu C. Evaluation of Contrast-Enhanced Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in the Detection of Retropharyngeal Lymph Node Metastases in Nasopharyngeal Carcinoma Patients. Cancer Manag Res 2020; 12:1733-1739. [PMID: 32210614 PMCID: PMC7069559 DOI: 10.2147/cmar.s244034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 02/21/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction We performed this study to explore the diagnostic accuracies and cutoff values of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) for the detection and diagnosis of metastatic retropharyngeal lymph nodes (RLNs) in patients with nasopharyngeal carcinoma (NPC). Methods One hundred and twenty-eight patients with a total of 159 RLNs were included in the study. The sizes of maximal and minimal axial diameters of each node on both contrast-enhanced CT and MRI images were measured. The characteristics of the RLNs (malignant or benign), as well as the survival of patients, were classified based on the results of follow-up MRI. Results RLN size cutoffs of 4–11 mm for minimal axial diameter were used. We found that MRI showed higher sensitivity while CT demonstrated higher specificity. The reasonable criterion for the diagnosis of metastatic RLNs in MRI was a minimal axial diameter of ≥6 mm, which yielded a sensitivity, specificity and diagnostic odds ratio (DOR) of 0.71, 0.82 and 10.88. Conclusion The radiologic criteria that should be used for the assessment of RLN metastases in NPC patients are nodes with a minimal axial diameter of ≥6 mm on MR images.
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Affiliation(s)
- Jie Chen
- Department of Oncology, Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Jingwen Luo
- Department of Oncology, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xia He
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Chenjing Zhu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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Dou S, Li R, Zhang L, Wang Z, Xie L, Zhang C, Zhu G. Long-term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study. Cancer Med 2020; 9:1712-1720. [PMID: 31953927 PMCID: PMC7050068 DOI: 10.1002/cam4.2856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/14/2019] [Accepted: 01/05/2020] [Indexed: 12/24/2022] Open
Abstract
Objective Controversy still exists regarding the volume of radiation for head and neck cancer of unknown primary (HNCUP). Theoretically, elective mucosal irradiation (EMI) should achieve a balance between survival and toxicity. This prospective study was conducted to evaluate the long‐term benefit of EMI in Chinese HNCUP patients. Methods A phase II, single‐arm trial was performed at two centers in China. HNCUP patients with pathologically confirmed metastatic squamous cell carcinoma or poorly differentiated carcinoma were enrolled. Patients with metastatic lymph nodes limited to level IV and/or the supraclavicular fossa were excluded. The EMI approach was specifically customized to Chinese patients by differentiating HNCUP as putative nasopharyngeal carcinoma (NPC) or non‐putative NPC. The primary endpoint was 3‐year mucosal recurrence‐free survival (MRFS). Results A total of 48 patients were enrolled between 02/02/2010 and 08/01/2018; 46 patients were analyzed, including 24 putative NPC and 22 non‐putative NPC patients. No primary recurrence was observed during a median follow‐up period of 70 months, and only 1 patient experienced out of field recurrence in the contralateral neck. The 3‐year MRFS was 90.6% (95%CI: 76.4%‐96.4%). The 5‐year MRFS, regional‐recurrence free survival (RRFS) and overall survival (OS) were 90.6% (95%CI: 76.4%‐96.4%), 86.0% (95%CI: 71.1%‐93.7%), and 90.6% (95%CI: 76.4%‐96.4%), respectively. No grade 4 acute or late toxicities occurred, and the most frequent grade 3 acute toxicity was oral mucositis (45.7%). Conclusion To the best of our knowledge, this is the first prospective study to evaluate the long‐term outcomes of EMI in Chinese HNCUP patients. Excellent MRFS and OS rates were observed. Further randomized studies are warranted.
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Affiliation(s)
- Shengjin Dou
- Radiotherapy Division, Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Rongrong Li
- Radiotherapy Division, Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Lin Zhang
- Radiotherapy Division, Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhuoying Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li Xie
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenping Zhang
- National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China.,Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guopei Zhu
- Radiotherapy Division, Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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Retropharyngeal Lymph Node Involvement in Oropharyngeal Carcinoma: Impact upon Risk of Distant Metastases and Survival Outcomes. Cancers (Basel) 2019; 12:cancers12010083. [PMID: 31905773 PMCID: PMC7016660 DOI: 10.3390/cancers12010083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 12/28/2022] Open
Abstract
The influence of retropharyngeal lymph node (RPLN) involvement on prognosis in oropharyngeal carcinoma remains poorly defined. The aim of this study was to assess the impact of RPLN involvement upon outcomes. A single-centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated nonsurgically between 2010 and 2017 was performed. All had a baseline 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG) PET-CT and contrast-enhanced MRI and/or CT. RPLN status was determined by radiology review of cases with reported abnormal RPLN. Multivariate backwards logistic regression was used to examine impact on outcomes of factors. Abnormal RPLNs were identified in 40/402 (10%) of patients. Median follow up was 42.9 months. RPLN involvement was associated with inferior 3 year outcomes for overall survival (OS) (67.1% vs. 79.1%, p = 0.006) and distant metastases-free survival (DMFS) (73.9% versus 88.0%, p = 0.011), with no significant difference in local control (81.6% vs. 87.7%, p = 0.154) or regional control (80.7% vs. 85.4%, p = 0.252). On multivariate analysis abnormal RPLN, no concurrent chemotherapy and ongoing smoking were associated with inferior DMFS and OS, while advanced T stage was also associated with inferior OS. In summary, RPLN involvement, present in 10% of patients, was an independent prognostic factor for the development of distant disease failure translating into inferior OS. These findings need confirmation in future studies.
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Oikawa Y, Michi Y, Tsushima F, Tomioka H, Mochizuki Y, Kugimoto T, Osako T, Nojima H, Yokokawa M, Kashima Y, Harada H. Management of retropharyngeal lymph node metastasis in oral cancer. Oral Oncol 2019; 99:104471. [PMID: 31678766 DOI: 10.1016/j.oraloncology.2019.104471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/19/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Retropharyngeal lymph node (RPLN) metastasis is extremely rare, and prognosis is significantly poor in oral cancer. We retrospectively examined the management of RPLN metastases in oral cancer. MATERIALS AND METHODS A total of 1247 patients with oral cancer were treated at our department from January 2002 and December 2016. Among these patients, 374 (30%) had histologically positive lymph node metastases. Of these, 15 patients (1.2%) were diagnosed with RPLN metastases. We evaluated the diagnostic period, size, recurrence pattern, laterality, treatment, and therapeutic outcomes. The Kaplan-Meier method was used to determine overall survival (OS) among the RPLN metastasis group, cervical lymph node (CLN) metastases group, and treatment methods group for RPLN metastases. RESULTS One patient had RPLN involvement at the initial treatment, and RPLN involvement in other patients was found subsequently. The mean duration in confirming RPLN metastases was 228 days (range, 50-867 days). Surgical therapy was performed in 5 patients, chemoradiotherapy in 7 patients, and best supported care (BSC) in 3 patients. The cumulative 5-year OS rate for the RPLN metastasis group (n = 15) was 38.1%, compared with the rate of 71.3% for the CLN group (n = 359). Regarding the therapeutic approach for RPLN metastases, OS rates were 80.0% (n = 5) in the surgical therapy group, 28.6% (n = 7) in the chemoradiotherapy group, and 0% (n = 3) in the BSC group. CONCLUSION Early detection and surgical treatment of RPLN metastases are associated with increased survival rate in oral cancer.
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Affiliation(s)
- Yu Oikawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yasuyuki Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumihiko Tsushima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuma Kugimoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Osako
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitomi Nojima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Misaki Yokokawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihisa Kashima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Iyizoba-Ebozue Z, Murray LJ, Arunsingh M, Vaidyanathan S, Scarsbrook AF, Prestwich RJD. Incidence and patterns of retropharyngeal lymph node involvement in oropharyngeal carcinoma. Radiother Oncol 2019; 142:92-99. [PMID: 31431388 DOI: 10.1016/j.radonc.2019.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/27/2019] [Accepted: 07/17/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim was to evaluate in oropharyngeal carcinoma the: (1) incidence and predictors of retropharyngeal (RP) lymph node (LN) involvement, (2) pattern of ipsilateral/bilateral/contralateral-only RP LNs (3) location of RP LNs in relation to contouring guidelines. METHODS Single centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated non-surgically between 2010 and 2017. All patients had a baseline FDG PET-CT and contrast-enhanced MRI and/or CT. All cases with reported abnormal RP LNs underwent radiology review. RESULTS Abnormal RP LNs were identified in 40/402 (10%) of patients. On multivariate analysis, RP LN involvement was associated with posterior pharyngeal wall/soft palate primaries (OR 10.13 (95% CI 2.29-19.08), p = 0.002) and contralateral cervical LN involvement (OR 2.26 (95% CI 1.05-4.86), p = 0.036). T stage, largest LN size, levels of ipsilateral LN level involvement, HPV and smoking status did not predict risk. 5/402 (1.2%) patients had bilateral RP involvement. 3/402 patients (0.7%) had contralateral-only RP LNs. All patients with contralateral RP LNs had contralateral neck nodes or primary cancers extending across midline. In 5/40 (12.5%) cases with involved RP LNs, the RP LNs were superior to hard palate/upper edge of body of C1 vertebra. CONCLUSIONS RP LNs were identified in 10% of oropharyngeal carcinoma patients, and were associated with contralateral neck disease and/or posterior pharyngeal wall/soft palate primary. Contralateral RP LN involvement was rare and associated with contralateral neck disease and/or primary crossing midline, suggesting potential for omission from target volumes for selected patients. Involvement of RP LNs close to the skull base highlights the need for generous elective outlining.
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Affiliation(s)
| | - Louise J Murray
- Department of Clinical Oncology, Leeds Cancer Centre, UK; Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | | | | | - Andrew F Scarsbrook
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Nuclear Medicine and Radiology, Leeds Cancer Centre, UK
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25
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Current thinking on the management of abnormal retropharyngeal nodes in patients with oral, oropharyngeal, and nasopharyngeal squamous cell carcinoma: a structured review. Br J Oral Maxillofac Surg 2019; 57:515-528. [DOI: 10.1016/j.bjoms.2019.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/24/2019] [Indexed: 12/19/2022]
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26
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Huang L, Zhang Y, Liu Y, Li H, Wang S, Liang S, Zhou J, Cui C, Sun Y, Chen M, Xu S, Li J, Liu L. Prognostic value of retropharyngeal lymph node metastasis laterality in nasopharyngeal carcinoma and a proposed modification to the UICC/AJCC N staging system. Radiother Oncol 2019; 140:90-97. [PMID: 31195216 DOI: 10.1016/j.radonc.2019.04.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Metastasis laterality is used for N classification of cervical lymph nodes, but not retropharyngeal lymph nodes (RLNs). This study explored the prognostic value of laterality of RLN metastasis to provide suggestions for a better N standard classification. MATERIALS AND METHODS This retrospective study evaluated 1225 patients with new biopsy-confirmed nasopharyngeal carcinoma (NPC). Univariable and multivariable Cox regression models were used to assess overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). A new N classification system was developed and compared to the 8th AJCC system. Kaplan-Meier methods with log-rank tests were used to compare OS, PFS, and DMFS between our proposed N stage and the AJCC N stages. RESULTS The incidence of RLN metastasis was 38.7% (unilateral) and 27.5% (bilateral). In the N1 subgroup, metastasis laterality was associated with significant differences in the 5-year rates of OS (89.4% vs. 82.6%, p = 0.016), DMFS (91.5% vs. 82.9%, p = 0.004), and PFS (80.3% vs. 71.2%, p = 0.016). However, no significant differences in these outcomes were observed when we compared N2 disease to N1 bilateral RLN metastasis. Multivariate analysis confirmed that bilateral RLN metastasis independently predicted OS, DMFS, and PFS. The proposed classification broadened the differences in OS, DMFS, PFS between N1 and N2 disease. CONCLUSION Patients with NPC and unilateral RLN metastasis had better survival than did patients with bilateral RLN metastasis. Upgrading cases with bilateral RLN metastasis from N1 to N2 may help improve prognostication using the 8th AJCC system.
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Affiliation(s)
- Ling Huang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Yun Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Yifei Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Shunxin Wang
- Zhongshan School of Medical, Sun Yat-sen University, China.
| | - Shaobo Liang
- Department of Radiation Oncology, Cancer Center, The First People's Hospital of Foshan Affiliated to Sun Yat-sen University, China.
| | - Jian Zhou
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Chunyan Cui
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Yin Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Minyuan Chen
- Department of Nasopharyngeal Cancer, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Shuoyu Xu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Jianjun Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.
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Teshima M, Otsuki N, Shinomiya H, Morita N, Furukawa T, Morimoto K, Nakamura T, Hashikawa K, Kiyota N, Sasaki R, Nibu KI. Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer. Head Neck 2019; 41:1738-1744. [PMID: 30620443 DOI: 10.1002/hed.25608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/23/2018] [Accepted: 12/10/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the impact of retropharyngeal lymph node (RPLN) dissection in the surgical treatment of hypopharyngeal cancer. METHODS Between 2007 and 2016, 98 previously untreated patients with pathological diagnosed hypopharyngeal squamous cell carcinoma underwent total pharyngolaryngectomy and bilateral neck dissection at Kobe University Hospital. Bilateral dissection of RPLN was simultaneously performed in all patients. Pharynx was reconstructed with free jejunal transfer in 94 patients and primarily closed in 4 patients. Postoperative chemoradiotherapy was performed in patients with high risk factors including metastasis to RPLN, multiple lymph node metastasis, extranodal invasion, and/or positive/close surgical margins. RESULTS The median follow-up period was 25 months ranging from 1 to 105 months. RPLN adenopathy was preoperatively identified in 9 patients in FDG-positron emission tomography. All of them had pathologically diagnosed RPLN metastases, which had been controlled in all patients during the observation periods. Among the other 89 patients, 7 patients had RPLN metastasis. The 2-year overall survival rates of the patients with and without RPLN metastasis were 65.7% and 69.8% (P = .61), respectively. CONCLUSIONS In the present study, patients with RPLN metastasis showed equally favorable oncological outcome compared with patients without RPLN metastasis. At least, ipsilateral RPLN dissection should be considered in the surgical treatment of advanced hypopharyngeal cancer and multiple neck lymph node metastasis regardless of primary subsite.
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Affiliation(s)
- Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naruhiko Morita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Koichi Morimoto
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tetsu Nakamura
- Department of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naomi Kiyota
- Department of Medical Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryohei Sasaki
- Radiation Onocology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Nagatsuka M, Hughes RT, Shenker RF, Frizzell BA, Greven KM. Omitting Elective Irradiation of the Contralateral Retropharyngeal Nodes in Oropharyngeal Squamous Cell Carcinoma Treated with Intensity-modulated Radiotherapy. Cureus 2019; 11:e3825. [PMID: 30868038 PMCID: PMC6402860 DOI: 10.7759/cureus.3825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: The use of intensity-modulated radiation therapy (IMRT) in head and neck cancers has allowed for selective sparing of low-risk or uninvolved lymph nodes. In oropharyngeal cancers, the benefits and risks of omitting contralateral retropharyngeal lymph nodes (RPLN) remain uncertain. This study examines the outcomes of elective coverage of contralateral RPLN in oropharyngeal cancer treated with definitive IMRT. Methods: We analyzed 54 patients with newly diagnosed unilateral tonsil or base of tongue squamous cell carcinoma with at most unilateral neck involvement (cN0-N2b) and no RPLN involvement. These patients had no prior head and neck irradiation and were treated with definitive radiotherapy or chemoradiotherapy between 2012 and 2017. Cumulative incidences of local/regional/distant failure were estimated using competing risks methodology, and overall survival (OS) was estimated using the Kaplan-Meier method. Results: All patients received elective nodal coverage to the ipsilateral RPLN, and 38 (62%) patients did not receive elective treatment of the contralateral RPLN. There were no significant differences in baseline characteristics. There were no contralateral RPLN failures observed. When comparing patients who received contralateral RP treatment with those who did not, there were no significant differences in two-year local failure (23% vs. 9%, p = 0.09), regional failure (18% vs. 4%, p = 0.12), or distant failure (15% vs. 9%, p = 0.62). Two-year OS was 89%. Mean parotid dose was not significantly lower after sparing vs. treating the contralateral RPLN (median 25.6 vs. 32.7 Gy, p = 0.15). Conclusions: The omission of contralateral RPLN irradiation in tonsil or tongue base carcinomas with unilateral neck involvement is safe without compromising disease control.
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Affiliation(s)
- Moeko Nagatsuka
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Ryan T Hughes
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Rachel F Shenker
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Bart A Frizzell
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Kathryn M Greven
- Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
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Transoral Robotic Surgery With Transoral Retropharyngeal Lymph Node Dissection in Patients With Tonsillar Cancer. J Craniofac Surg 2019; 30:145-148. [DOI: 10.1097/scs.0000000000004994] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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30
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He LJ, Xie C, Li Y, Luo LN, Pan K, Gao XY, Liu LZ, Gao JM, Luo GY, Shan HB, Chen MY, Zhao C, Fan WJ, Yang P, Xu GL, Li JJ. Ultrasound-guided fine needle aspiration of retropharyngeal lymph nodes after radiotherapy for nasopharyngeal carcinoma: a novel technique for accurate diagnosis. Cancer Commun (Lond) 2018; 38:20. [PMID: 29764509 PMCID: PMC5993149 DOI: 10.1186/s40880-018-0286-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background Enlarged retropharyngeal lymph nodes (RLNs) are very common in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. The most suitable treatment option for enlarged RLNs depends on the pathological results. However, RLN sampling is difficult and imminent in the clinic setting. We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for sampling RLN tissues sufficient for pathological or cytological diagnosis. Methods We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via magnetic resonance imaging (MRI). The EUS probe was introduced into the nasopharynx via the nostrils, and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath. EUS-FNA was subsequently performed. The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed. Results Strips of tissue were successfully sampled from all patients using EUS-FNA. Of the 30 patients, 23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session. The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session, and two more cases were confirmed possessing cancer cells. The other five patients without confirmed cancer cells were closely followed with MRI every month for 3 months. After follow-up for 3 months, three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters. The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive. In the whole cohort reported here, the EUS-FNA procedure was not associated with any severe complications. Conclusion EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC. Electronic supplementary material The online version of this article (10.1186/s40880-018-0286-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Long-Jun He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Chuanbo Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Yin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Lin-Na Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Ke Pan
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77054, USA
| | - Xiao-Yan Gao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Li-Zhi Liu
- Department of Imaging and Invention Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Jian-Ming Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Guang-Yu Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Hong-Bo Shan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Chong Zhao
- Department of Nasopharyngeal Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Wei-Jun Fan
- Department of Imaging and Invention Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Ping Yang
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Guo-Liang Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Jian-Jun Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
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Treatment for retropharyngeal metastatic undifferentiated squamous cell carcinoma from an unknown primary site: results of a prospective study with irradiation to nasopharyngeal mucosa plus bilateral neck. Oncotarget 2018; 8:42372-42381. [PMID: 28418897 PMCID: PMC5522073 DOI: 10.18632/oncotarget.16344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/21/2017] [Indexed: 12/26/2022] Open
Abstract
Background and Objective To evaluate treatment outcomes for patients with retropharyngeal metastatic undifferentiated squamous cell carcinoma (SCC) from an unknown primary site. Methods From January 2005 to January 2015, patients who presented with enlarged retropharyngeal nodes underwent transoral sonography-guided fine-needle aspiration to confirm histology. Those with metastatic undifferentiated SCC with unknown primary tumors were treated with radical radiotherapy to nasopharyngeal mucosa plus bilateral neck. Chemotherapy was administered for patients staged N2-3. Endpoints included metastatic nodes control, the appearance of primary tumor, overall survival and treatment-related toxicities. Results A total of 49 patients were recruited into this study. Retropharyngeal and cervical nodal disease was controlled in 96% of all patients. The incidence of occult primary cancer appearance was 8%. No primary cancer other than of the nasopharynx was detected during the course of follow-up. Ten patients developed distant metastases. The 5-year overall survival, progression-free survival, regional relapse free survival, distant metastasis free survival were 79.6%, 61.1%, 83.4%, 73.8%, respectively. Common late adverse effects included xerostomia (57%) and hearing impairment (35%). Conclusion Radical radiotherapy to both the nasopharynx and bilateral neck can achieve excellent outcome with mild toxicities for patients with retropharyngeal metastatic undifferentiated squamous cell carcinoma from an unknown primary site.
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Yamazaki H, Sasaki M, Aoyama KI, Suzuki T, Denda Y, Uchibori M, Nakanishi Y, Kojima R, Ota Y. Lateral retropharyngeal lymph node metastasis from squamous cell carcinoma of the upper gingiva: A case report. Mol Clin Oncol 2018; 8:68-72. [PMID: 29399347 PMCID: PMC5772686 DOI: 10.3892/mco.2017.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/09/2017] [Indexed: 12/05/2022] Open
Abstract
Lateral retropharyngeal lymph node (LRPLN) is located between the internal carotid artery and the prevertebral muscles. Metastasis to the LRPLN is frequent in nasopharyngeal cancer, but is rare in oral cancer. The prognosis of patients with oral cancer with LRPLN metastasis is usually poor. The present study reported a patient with LRPLN metastasis from squamous cell carcinoma of the upper gingiva, who survived for >7 years. Docetaxel, cisplatin and fluorouracil (TPF) therapy was performed as induction chemotherapy and it was planned to subsequently conduct chemoradiotherapy or surgery. As the tumor only exhibited a transient response to TPF, surgery was selected. Postoperatively, only radiotherapy was performed and a favorable outcome was achieved.
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Affiliation(s)
- Hiroshi Yamazaki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.,Department of Oral and Maxillofacial Surgery, Tokai University Oiso Hospital, Kanagawa 259-0198, Japan
| | - Masashi Sasaki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Ken-Ichi Aoyama
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.,Department of Oral and Maxillofacial Surgery, Tokai University Oiso Hospital, Kanagawa 259-0198, Japan
| | - Takatsugu Suzuki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Yuya Denda
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Masahiro Uchibori
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Yasuhiro Nakanishi
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Rena Kojima
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.,Department of Oral and Maxillofacial Surgery, Tokai University Oiso Hospital, Kanagawa 259-0198, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
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Gavid M, Dumollard JM, Habougit C, Lelonge Y, Bergandi F, Peoc'h M, Prades JM. Anatomical and histological study of the deep neck fasciae: does the alar fascia exist? Surg Radiol Anat 2018; 40:917-922. [PMID: 29380103 DOI: 10.1007/s00276-018-1977-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/18/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine whether the alar fascia is a distinct layer of the deep cervical neck fasciae. The present study also aimed to elucidate the anatomical limits of this fascia. METHODS Neck dissections of ten adult cadavers were performed, layer by layer, in the retropharyngeal region, under a powered operating microscope. Detailed dissections revealed the anatomical limits of the deep neck fasciae. Histological descriptions were also performed on large tissue samples collected from three cervical dissections. RESULTS In the ten dissections, three layers of fascia were identified and dissected in the retropharyngeal region: a visceral fascia, a prevertebral fascia and an alar fascia. The alar fascia appeared like a connecting band derivative of the visceral fascia, between both vascular sheaths. It fused completely with the visceral fascia anteriorly at the level of T2 and with the prevertebral fascia posteriorly at the level of C1. No sagittal connection between the visceral fascia and the prevertebral fascia was identified. The stained histological sections confirmed the presence of the visceral and prevertebral fasciae at the oropharyngeal level, with a third intermediate layer closely connected with the visceral fascia. CONCLUSION The alar fascia is a layer of the cervical neck fascia connected with the visceral fascia from C1 to T2 levels. The anatomical limits of this alar fascia and its relationships with the internal carotid artery are important in the surgical management and the prognosis of deep neck infections and retropharyngeal lymph node metastases.
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Affiliation(s)
- M Gavid
- Department of Anatomy, Jean Monnet University, Saint-Etienne, France.
- Department of Otorhinolaryngology Head Neck Surgery, CHU Saint-Etienne, Saint-Etienne, France.
| | - J M Dumollard
- Department of Anatomopathology, CHU Saint-Etienne, Saint-Etienne, France
| | - C Habougit
- Department of Anatomopathology, CHU Saint-Etienne, Saint-Etienne, France
| | - Y Lelonge
- Department of Otorhinolaryngology Head Neck Surgery, CHU Saint-Etienne, Saint-Etienne, France
| | - F Bergandi
- Department of Anatomy, Jean Monnet University, Saint-Etienne, France
| | - M Peoc'h
- Department of Anatomopathology, CHU Saint-Etienne, Saint-Etienne, France
| | - J M Prades
- Department of Anatomy, Jean Monnet University, Saint-Etienne, France
- Department of Otorhinolaryngology Head Neck Surgery, CHU Saint-Etienne, Saint-Etienne, France
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34
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Fujiwara K, Fukuhara T, Koyama S, Donishi R, Kataoka H, Kitano H, Takeuchi H. Ultrasound-Guided Transoral Videolaryngoscopic Surgery for Retropharyngeal Lymph Node Metastasis of Papillary Thyroid Cancer. Case Rep Oncol 2017; 10:649-655. [PMID: 28868026 PMCID: PMC5566694 DOI: 10.1159/000478653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 11/23/2022] Open
Abstract
Background Endoscopic-assisted transoral surgery, including transoral robotic surgery for metastatic retropharyngeal lymph node (RPN) from well-differentiated thyroid cancer, has been reported to reduce the complications resulting from transcervical and transmandibular approaches. However, the narrow working space and difficulty identifying RPN are problematic. To solve these issues, several studies have used intraoperative ultrasound in endoscopic-assisted transoral surgery. However, the type of ultrasonography suitable for this purpose remains unclear. Case Presentation A 60-year-old female with thyroid papillary carcinoma (T4aN1bM0) initially underwent total thyroidectomy and paratracheal and selective neck dissections (D2a), with resectional management of recurrent laryngeal nerve, trachea, and esophagus. Three years later, she was diagnosed with left retropharyngeal and upper mediastinal lymph node metastases of papillary thyroid cancer. Transoral videolaryngoscopic surgery was performed with a combination of ultrasonography with a flexible laparoscopic transducer manipulated with forceps for identifying RPN intraoperatively. Due to the transducer's small size and thin, flexible cable, the transducer interrupted the procedure in spite of the narrowness of oral cavity. RPN was resected completely without adverse events. Conclusion We performed intraoperative ultrasound-guided endoscopic transoral surgery for metastatic RPN from papillary thyroid cancer and achieved complete resection as well as preservation of swallowing function.
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Affiliation(s)
- Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takahiro Fukuhara
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Satoshi Koyama
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryohei Donishi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hideyuki Kataoka
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroya Kitano
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Pollard C, Nguyen TP, Ng SP, Frank SJ, Garden AS, Gunn GB, Fuller CD, Beadle BM, Morrison WH, Shah SJ, Wang H, Tung S, Wang C, Ginsberg LD, Zafereo ME, Sturgis EM, Su SY, Hanna EY, Rosenthal DI, Phan J. Clinical outcomes after local field conformal reirradiation of patients with retropharyngeal nodal metastasis. Head Neck 2017; 39:2079-2087. [PMID: 28741749 DOI: 10.1002/hed.24872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/11/2017] [Accepted: 05/29/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to present our experience with retropharyngeal node reirradiation using highly conformal radiotherapy (RT). METHODS A retrospective screen of 2504 consecutively irradiated patients with head and neck malignancies between 2005 and 2015 identified 19 patients who underwent reirradiation for retropharyngeal node metastasis. Clinical and toxicity outcomes were assessed in these patients. RESULTS Thirteen patients (68%) had squamous cell carcinoma. Eleven patients (58%) received conventionally fractionated intensity-modulated radiotherapy (IMRT) or proton therapy, and 8 patients (42%) received single-fractionated or hypofractionated stereotactic RT. Fourteen patients (74%) received chemotherapy. Median follow-up was 14.7 months. The 1-year local control, locoregional control, overall survival, and progression-free survival rates were 100%, 94%, 92%, and 92%, respectively. Three patients (16%) experienced acute grade 3 toxicity and occurred in those treated with IMRT. There was no late grade ≥3 toxicity. CONCLUSION Retropharyngeal node reirradiation with conformal therapy is well tolerated and associated with excellent short-term disease control.
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Affiliation(s)
- Courtney Pollard
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Theresa P Nguyen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sweet Ping Ng
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary B Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - William H Morrison
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shah J Shah
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - He Wang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sam Tung
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Conjun Wang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lawrence D Ginsberg
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark E Zafereo
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shirley Y Su
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Gangl K, Nemec S, Altorjai G, Pammer J, Grasl MC, Erovic BM. Prognostic survival value of retropharyngeal lymph node involvement in sinonasal tumors: A retrospective, descriptive, and exploratory study. Head Neck 2017; 39:1421-1427. [PMID: 28452184 DOI: 10.1002/hed.24782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 10/26/2016] [Accepted: 02/10/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sinonasal carcinomas are rare. The purpose of this study was for us to present our assessment of the effects of retropharyngeal lymph node involvement at diagnosis on patient outcomes. METHODS Retropharyngeal lymph node involvement in 36 patients with sinonasal carcinoma was determined by radiology at initial presentation. Clinical outcome, in particular, overall survival (OS) and locoregional control, was assessed by Kaplan-Meier analysis and log-rank testing. RESULTS Retropharyngeal lymph node involvement was associated with statistically significant decreased OS (P = .0066) in the patient collective. In the squamous cell carcinoma (SCC) subgroup (n = 23), decreased OS (P = .0046) and worse locoregional control (P = .0065) were observed. In these patients, decreased OS (P = .0423) and worse locoregional control (P = .0315) were also seen in the advanced tumor subgroup. CONCLUSION Retropharyngeal lymph node involvement at diagnosis is a significant prognostic factor for decreased OS and locoregional control in sinonasal carcinoma.
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Affiliation(s)
- Katharina Gangl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Gabriela Altorjai
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Johannes Pammer
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Matthaeus Ch Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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37
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Leeman JE, Gutiontov S, Romesser P, McBride S, Riaz N, Lee N, Tsai CJ. Sparing of high retropharyngeal nodal basins in patients with unilateral oropharyngeal carcinoma treated with intensity modulated radiation therapy. Pract Radiat Oncol 2016; 7:254-259. [PMID: 28094212 DOI: 10.1016/j.prro.2016.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The introduction of intensity modulated radiotherapy (IMRT) has facilitated dose painting and sparing of uninvolved/low-risk nodal basins in head and neck cancers. In oropharynx cancer (OPC), the need for elective coverage of uninvolved high contralateral retropharyngeal (RP) nodes and the risk associated with sparing this region remain unclear. We examined outcomes of OPC patients treated with IMRT and omission of contralateral high RP coverage. METHODS AND MATERIALS We identified 102 OPC patients with cN0-N2b disease treated with definitive IMRT with or without concurrent chemotherapy between 2010 and 2013. The contralateral RP nodal basins superior to the vertebral level of C1 were omitted from the elective IMRT field for all patients. Of the 67 patients (66%) with p16 status available, 63 (94%) were p16+. We used the Kaplan-Meier method to estimate overall survival, as well as freedom from local failure, regional failure, distant failure, and retropharyngeal failure. RESULTS The median follow-up was 26.9 months (range, 3.0-59.9 months). There were no failures in the treated ipsilateral RP nodes or the spared contralateral high RP nodes in the entire cohort. In the p16+ cohort and the entire cohort, the 2-year rates of overall survival and freedom from local, regional, distant, and retropharyngeal failure were 98.0% and 95.1%, 98.1% and 97.7%, 96.4% and 96.7%, 98.1% and 95.1%, and 100% and 100%, respectively. CONCLUSIONS Omission of contralateral high RP nodes in patients with p16+ OPC with unilateral disease is safe.
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Affiliation(s)
- Jonathan E Leeman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stanley Gutiontov
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Spector ME, Chinn SB, Bellile E, Gallagher KK, Kang SY, Moyer JS, Prince ME, Wolf GT, Bradford CR, McHugh JB, Carey TE, Worden FP, Eisbruch A, Ibrahim M, Chepeha DB. Exploration for an Algorithm for Deintensification to Exclude the Retropharyngeal Site From Advanced Oropharyngeal Squamous Cell Carcinoma Treatment. JAMA Otolaryngol Head Neck Surg 2016; 142:313-8. [PMID: 26892642 DOI: 10.1001/jamaoto.2015.3602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Understanding the drainage patterns to the retropharyngeal lymph nodes is an important consideration in oropharyngeal squamous cell carcinoma (OPSCC) because treatment of these nodes is related to increased morbidity. Prediction of these drainage patterns could not only help minimize treatment morbidity but also prevent failures in at-risk patients as deintensification trials are under way for this disease. OBJECTIVE To evaluate the prevalence of pathologic retropharyngeal adenopathy (RPA) in OPSCC relative to involvement of the oropharyngeal subsite, number of metastatic neck nodes, T classification, and N classification. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review from January 1, 2003, through December 31, 2010, at an academic referral center of 205 previously untreated patients with pathologically confirmed, advanced-stage (III, IV) OPSCC. Data analysis was performed from January 1, 2013, through June 30, 2015. EXPOSURE Concurrent chemoradiotherapy. MAIN OUTCOMES AND MEASURES Radiologic evidence of pathologic RPA was tabulated and related to involvement of the oropharyngeal subsite, number of metastatic neck nodes, T classification, and N classification. RESULTS Of the 205 previously untreated patients (183 men; mean age, 56.1 years), pathologic RPA was identified in 37 (18.0%) of the 205 patients. Pathologic retropharyngeal lymph nodes were found in 12 (13.5%) of 89 patients with base of tongue cancers, 24 (22.0%) of 109 patients with tonsil cancers, and 1 (14.3%) of 7 patients with other oropharyngeal subsite cancers. Increasing prevalence of RPA was positively correlated with closer proximity to the posterior tonsillar pillar. A multivariable logistic regression model using the oropharyngeal subsite, involvement of the posterior tonsillar pillar, number of metastatic neck nodes, T classification, and N classification revealed that the number of metastatic neck nodes was statistically significant (odds ratio, 1.44; 95% CI, 1.20-1.71; P < .001). CONCLUSIONS AND RELEVANCE The prevalence of pathologic RPA in this cohort was 18.0%, and patients with multiple nodes had the highest risk of pathologic RPA, followed by involvement of the posterior tonsillar pillar. However, these data suggest that there is no clear algorithm that can be used for deintensification to exclude the retropharyngeal site from the treatment volume using extent of disease gathered from pretreatment imaging for patients with advanced-stage OPSCC.
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Affiliation(s)
| | - Steven B Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - K Kelly Gallagher
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas
| | - Stephen Y Kang
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Jeffrey S Moyer
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Gregory T Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | | | | | - Thomas E Carey
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Francis P Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | | | - Douglas B Chepeha
- Department of Otolaryngology, University of Michigan, Ann Arbor8Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
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Effectiveness of superselective intra-arterial chemoradiotherapy targeting retropharyngeal lymph node metastasis. Eur Arch Otorhinolaryngol 2016; 273:3331-6. [PMID: 26874732 DOI: 10.1007/s00405-016-3933-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 02/08/2016] [Indexed: 12/21/2022]
Abstract
We sought to evaluate the efficacy and feasibility of superselective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (hereafter RADPLAT) for head and neck squamous cell cancer (hereafter HNSCC) patients with retropharyngeal lymph node (hereafter RPLN) metastasis. A retrospective case series review was conducted at University medical center in Japan. Ten HNSCC patients with RPLN metastasis treated by RADPLAT were analyzed. The ascending pharyngeal artery was targeted for the treatment of RPLN metastasis in 9 patients. The median total dose of cisplatin was 26.6 mg/m(2) (mean 31.5 mg/m(2), range 11.7-87.9 mg/m(2)). In the remaining patient, the RPLN was supplied by the ascending palatine artery. As grade 3 and 4 adverse effects, leukopenia was observed in three, mucositis in four and nausea in one patient. No neurological complications were observed in any patients. Metastatic RPLNs were evaluated as a complete response in all patients. There was no recurrence of RPLN metastasis in any patients. Four patients remain alive without any evidence of disease and six patients died of disease. The 5-year overall survival rate was 50 %. We have shown that superselective intra-arterial cisplatin infusion for RPLNs was a feasible and effective approach for HNSCC patients with RPLN metastasis.
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40
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Samuels SE, Eisbruch A, Beitler JJ, Corry J, Bradford CR, Saba NF, van den Brekel MWM, Smee R, Strojan P, Suárez C, Mendenhall WM, Takes RP, Rodrigo JP, Haigentz M, Rapidis AD, Rinaldo A, Ferlito A. Management of locally advanced HPV-related oropharyngeal squamous cell carcinoma: where are we? Eur Arch Otorhinolaryngol 2015; 273:2877-94. [PMID: 26463714 DOI: 10.1007/s00405-015-3771-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022]
Abstract
HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.
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Affiliation(s)
- Stuart E Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - June Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Missak Haigentz
- Division of Oncology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alexander D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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Baxter M, Chan JYK, Mydlarz WK, Labruzzo SV, Kiess A, Ha PK, Nafi A, Nishant A. Retropharyngeal lymph node involvement in human papillomavirus-associated oropharyngeal squamous cell carcinoma. Laryngoscope 2015; 125:2503-8. [DOI: 10.1002/lary.25495] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/08/2015] [Accepted: 06/17/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Michael Baxter
- Department of Otolaryngology; Naval Medical Center San Diego; San Diego California
| | - Jason Y. K. Chan
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Wojciech K. Mydlarz
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Salvatore V. Labruzzo
- Department of Radiology-Neuroradiology; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Ana Kiess
- Department of Radiation Oncology; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Patrick K. Ha
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Aygun Nafi
- Department of Radiology-Neuroradiology; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Agrawal Nishant
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
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Givi B, Troob SH, Stott W, Cordeiro T, Andersen PE, Gross ND. Transoral robotic retropharyngeal node dissection. Head Neck 2015; 38 Suppl 1:E981-6. [DOI: 10.1002/hed.24140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 03/26/2015] [Accepted: 05/31/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Babak Givi
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York New York
| | - Scott H. Troob
- Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland Oregon
| | - Will Stott
- Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland Oregon
| | - Teresa Cordeiro
- Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland Oregon
| | - Peter E. Andersen
- Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland Oregon
| | - Neil D. Gross
- Department of Head and Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
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Impact of retropharyngeal adenopathy on distant control and survival in HPV-related oropharyngeal cancer treated with chemoradiotherapy. Radiother Oncol 2015; 116:75-81. [PMID: 26094074 DOI: 10.1016/j.radonc.2015.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/05/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Retropharyngeal adenopathy (RPA) is poor prognostic factor in head and neck (HN) cancer. However, the prognostic significance of RPA in Human Papillomavirus-related (HPV+) oropharyngeal cancer (OPC) is unknown. PATIENTS AND METHODS 185 patients with HPV+OPC were assessed. Pre-therapy images reviewed by a HN radiologist to determine presence of RPA. Doses to the RPAs were determined from treatment plans. Outcomes analyzed using Kaplan-Meier method, log-rank tests, and correlations determined using Spearman's rank analyses. RESULTS 29 (16%) of the HPV+patients had RPA. At median follow-up 49months, 5-year overall survival (OS), failure-free survival (FFS) and distant failure-free survival (DFFS) were 57% vs. 81% (P=0.02), 63% vs 80% (P=0.015) and 70% vs 91% (P=0.002) for patients with/without RPA, respectively. No differences observed in local/ regional control rates, exceeding 90% in both groups, and No RPA recurrences were observed. In multivariable analysis, stages T4 or N3, and RPA, were independently, statistically significantly associated with both OS and distant failure, while N2c, age, disease site, and smoking status, were not. CONCLUSION RPA in HPV+OPC is an independent prognostic factor for distant failure, translating into worse OS. Patients with RPA may not be suitable candidates for trials of systemic treatment de-escalation.
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Chung EJ, Kim GW, Cho BK, Cho SJ, Yoon DY, Rho YS. Retropharyngeal Lymph Node Metastasis in 54 Patients with Oropharyngeal Squamous Cell Carcinoma Who Underwent Surgery-Based Treatment. Ann Surg Oncol 2015; 22:3049-54. [DOI: 10.1245/s10434-014-4364-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Indexed: 11/18/2022]
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Surgical Management of Retropharyngeal Nodes Metastases from Papillary Thyroid Carcinoma. World J Surg 2014; 38:2831-7. [DOI: 10.1007/s00268-014-2707-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Homma A, Hayashi R, Matsuura K, Kato K, Kawabata K, Monden N, Hasegawa Y, Onitsuka T, Fujimoto Y, Iwae S, Okami K, Matsuzuka T, Yoshino K, Nibu KI, Kato T, Nishino H, Asakage T, Ota I, Kitamura M, Kubota A, Ueda T, Ikebuchi K, Watanabe A, Fujii M. Lymph node metastasis in t4 maxillary sinus squamous cell carcinoma: incidence and treatment outcome. Ann Surg Oncol 2014; 21:1706-10. [PMID: 24554063 DOI: 10.1245/s10434-014-3544-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the incidence of lymph node metastasis among patients with T4 maxillary sinus squamous cell carcinoma (MS-SCC) as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. METHODS Consecutive series of all patients (n = 128) with previously untreated T4 maxillary sinus SCC between 2006 and 2007 were obtained from 28 institutions belonging to or cooperating in the Head and Neck Cancer Study Group of the Japan Clinical Oncology Group. RESULTS Of the 128 patients, 28 (21.9 %) had lymph node metastasis, and six patients (4.7 %) had distant metastasis at diagnosis. Among the 111 patients who were treated with curative intent, 98 had clinically N0 neck disease and did not receive prophylactic neck irradiation. A total of 11 patients (11.2 %) subsequently developed evidence of lymph node metastasis, of whom eight were among the 83 patients with an N0 neck and had not received elective neck treatment. There were 15 patients who received an elective neck dissection as part of the initial treatment, of whom three had pathologically positive for lymph node metastases. Of 11 patients, six patients with nonlateral retropharyngeal lymph node metastasis without primary or distant disease were successfully salvaged. CONCLUSIONS This study identified the incidence of lymph node metastasis among patients with T4 MS-SCC as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. These results will be of assistance in selecting treatment strategy for T4 MS-SCC in the future.
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Affiliation(s)
- Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan,
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Shi Q, Shen C, Kong L, Wang X, Ding J, Gao Y, Xu T, Hu C. Involvement of both cervical lymph nodes and retropharyngeal lymph nodes has prognostic value for N1 patients with nasopharyngeal carcinoma. Radiat Oncol 2014; 9:7. [PMID: 24393418 PMCID: PMC3996203 DOI: 10.1186/1748-717x-9-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 12/21/2013] [Indexed: 11/25/2022] Open
Abstract
Background The N1 definition of 2010 UICC/AJCC staging system for nasopharyngeal carcinoma (NPC) covers quite a large range of nodal pattern. The objective of this research is to investigate prognostic value of lymph nodes related factors including involvement of both cervical lymph nodes (CLNs) and retropharyngeal lymph nodes (RLNs) or not, size and number of cervical lymph nodes (CLNs) in N1 patients with NPC. Methods 142 newly diagnosed non-metastatic N1 patients with NPC, staged according to the 2010 AJCC staging system for NPC were retrospectively enrolled. All patients had undergone contrast-enhanced magnetic resonance imaging (MRI), and received radiotherapy, with or without chemotherapy as their primary treatment. Results The median follow-up was 48 months. The 5-year local recurrence-free survival (LFS), nodal recurrence-free survival (NFS), local-regional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) of the whole group were 82.3%, 83.0%, 81.0%, 82.1%, 75.3% and 89.8%, respectively. In univariate analysis, patients with both CLNs and RLNs involvement showed a significant lower DMFS, PFS and LRFS than the rest patients (p = 0.004 p = 0.003 and p = 0.034, respectively). Neither size nor number of CLNs affected the survival. In multivariate analysis, involvement of both CLNs and RLNs was an independent prognostic factor for DMFS and PFS (p = 0.019, p = 0.019), but there was no enough evidence confirming its prognostic value for LRFS (p = 0.051). Conclusions For N1 patients with NPC, involvement of both RLNs and CLNs may be a potentially prognostic factor for distant metastasis and disease progression. The N stage for N1 patients with involvement of both cervical lymph nodes and retropharyngeal lymph nodes might need to be deliberated.
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Affiliation(s)
| | | | | | | | | | | | | | - Chaosu Hu
- Department of Radiation Oncology, Cancer Hospital of Fudan University, 270 Dong An Road, Shanghai, China.
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Harréus U. Surgical errors and risks - the head and neck cancer patient. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc04. [PMID: 24403972 PMCID: PMC3884539 DOI: 10.3205/cto000096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.
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Affiliation(s)
- Ulrich Harréus
- Department of Otolaryngology/Head and Neck Surgery, University Hospital Munich, Campus Grosshadern, Munich, Germany
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Tang C, Komakula S, Chan C, Murphy JD, Jiang W, Kong C, Lee-Enriquez N, Jensen KC, Fischbein NJ, Le QT. Radiologic assessment of retropharyngeal node involvement in oropharyngeal carcinomas stratified by HPV status. Radiother Oncol 2013; 109:293-6. [DOI: 10.1016/j.radonc.2013.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 09/02/2013] [Accepted: 09/02/2013] [Indexed: 11/30/2022]
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