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Witek ME, Morris CG, Alexander GS, Dontu P, Koroulakis AI, Regine WF, Mendenhall WM. Multi-institutional study of clinical outcomes of patients with head and neck cancer presenting with cN3 disease. Head Neck 2023; 45:1149-1155. [PMID: 36855018 DOI: 10.1002/hed.27326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND To evaluate disease control, toxicities, and variables associated with clinical outcomes for patients with head and neck squamous cell carcinoma and clinical N3 disease (HNSCC N3) treated with definitive chemoradiation therapy. METHODS We performed a retrospective review of patients with HNSCC N3 treated at two high-volume academic centers between 1996 and 2019. RESULTS We identified 85 patients with a median follow-up of 2.8 years. Five-year overall survival, regional control, and freedom from distant metastases rates were 38%, 80%, and 80%, respectively. Severe complications were identified in 19% of patients. CONCLUSIONS Favorable regional control is achievable with definitive chemoradiation therapy for patients with HNSCC N3 disease. Distant metastases are a common pattern of failure and should be a focus of prospective study.
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Affiliation(s)
- Matthew E Witek
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pragnya Dontu
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Antony I Koroulakis
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - William F Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
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2
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Sellami S, Leclere JC, Lucia F, Gobel Y, Uguen A, Rousset J, Gouders D, Pradier O, Marianowski R, Abgral R, Schick U. N3 (> 6 cm) squamous cell carcinoma of the head and neck: outcomes and predictive factors in 104 patients. ACTA ACUST UNITED AC 2021; 41:221-229. [PMID: 34264915 PMCID: PMC8283407 DOI: 10.14639/0392-100x-n1437] [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: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
Objective To report outcome and predictive factors in patients with N3 (> 6 cm) non-metastatic locally advanced head and neck squamous cell carcinoma (LAHNSCC) treated with a conservative approach or with initial surgery. Methods 104 patients were included: 69 treated with radiotherapy (RT) ± chemotherapy (CT) and 35 with nodal surgery with or without primary tumour resection, which was completed in 30 patients by adjuvant RT ± CT. Positron-emission tomography-computed tomography (PET-CT) guided surveillance after RT ± CT was standard. Results Two-year overall survival (OS) and locoregional control (LRC) were 39.4% and 37.5%, respectively. In univariate analysis, body mass index (BMI), performance status (PS), p16 status and haemoglobin value influenced OS and disease-free survival (DFS). In multivariate analysis, p16 positive status and BMI ≥ 25 remained independent prognostic factors for better OS (p = 0.023) and DFS (p = 0.002). Only under/normal weight remained an independent and adverse significant prognostic factor in multivariate analysis for regional control (RC). Patients treated with primary RT ± CT had slightly better 2-year OS (43.5% versus 33.3%, p = 0.31). Conclusions Patients with N3 LAHNSCC have poor prognosis, but long term LRC is achievable, especially in overweight patients and those with a good PS.
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Affiliation(s)
| | - Jean Christophe Leclere
- Oncology Department, University Hospital, Brest, France.,Head and Neck Surgery Unit, University Hospital, Brest, France
| | - François Lucia
- Oncology Department, University Hospital, Brest, France.,INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | - Yves Gobel
- Head and Neck Surgery Unit, University Hospital, Brest, France
| | - Arnaud Uguen
- Pathology Unit, University Hospital, Brest, France
| | - Jean Rousset
- Department of Radiology, University Hospital of Brest and Military Hospital, Brest, France
| | - Dominique Gouders
- Radiation Oncology Department, Hospital de Cornouaille, Quimper, France
| | - Olivier Pradier
- Oncology Department, University Hospital, Brest, France.,INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | | | - Ronan Abgral
- Nuclear Medicine, University Hospital, Brest, France
| | - Ulrike Schick
- Oncology Department, University Hospital, Brest, France.,INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
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3
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Virk JS, Ingle M, Podesta CM, Gujral DM, Awad Z. Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases. Clin Otolaryngol 2020; 45:342-349. [PMID: 31869000 DOI: 10.1111/coa.13501] [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: 07/03/2019] [Revised: 11/14/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Management of metastatic N3 nodal disease from primary head and neck squamous cell carcinoma (HNSCC) is controversial. Recently, there has been a move to observation of the neck for those who achieve complete response (CR) after chemoradiotherapy (CRT). We sought to determine survival outcomes for N3 nodal disease, particularly for patients with human papilloma virus (HPV)-positive HNSCC. METHODS We carried out a systematic search of MEDLINE and Embase for articles between 01/2008 and 12/2017. Articles on N3 nodal disease in HNSCC patients treated with CRT or surgery + adjuvant RT/CRT were included if they reported on oropharyngeal or HPV+ subgroups. Local control (LC), nodal control (NC), distant metastasis-free survival (DMFS), disease-free survival (DFS) or overall survival (OS) was assessed. RESULTS Nine studies met the inclusion criteria. Eight of these studies (N = 5304) allowed further comparison: 4 were on CRT, 2 on surgery + RT/CRT and 2 on both. Four of these eight studies and the remaining included study reported on residual nodal disease on histology after neck dissection (ND) following CRT. Patients treated with CRT achieved LC rates of 77%-94% at 2-3 years; those who had a CR had LC of >90%. Better NC was noted in patients who achieved a CR. Three-year OS was better for HPV+ HNSCC (range, 55.2%-81%). Patients with CR had better survival outcomes (DMFS 77% at 3 years vs 69.8% for HPV+; OS 68.9% at 3 years vs 55.2% for HPV+). Primary surgery demonstrated similar survival for HPV+ vs HPV- and better survival in oropharyngeal cancers. Five-year DFS rates varied from 30% to 87%, and OS from 26.6% to 84%. For patients with non-CR, positive histology rates varied from 27.3% to 100%, with average positive histology rates of 27.3% in HPV+ patients with non-CR vs 60% for HPV- patients with non-CR. CONCLUSION The current literature does not support the de-escalation of treatment with HPV- N3 disease. Observation of HPV+ patients who achieve a CR post-CRT is reasonable but further prospective studies are required given the heterogeneity and risk of bias within these current studies. Planned ND should remain standard of care for non-CR cohort.
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Affiliation(s)
- Jagdeep S Virk
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Manasi Ingle
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Clinical oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Christine M Podesta
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Clinical oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Dorothy M Gujral
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Clinical oncology, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Zaid Awad
- Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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Chen WY, Chen TC, Lai SF, Liang THK, Huang BS, Wang CW. Outcome of bimodality definitive chemoradiation does not differ from that of trimodality upfront neck dissection followed by adjuvant treatment for >6 cm lymph node (N3) head and neck cancer. PLoS One 2019; 14:e0225962. [PMID: 31794576 PMCID: PMC6890260 DOI: 10.1371/journal.pone.0225962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/16/2019] [Indexed: 11/18/2022] Open
Abstract
Currently, data regarding optimal treatment modality, response, and outcome specifically for N3 head and neck cancer are limited. This study aimed to compare the treatment outcomes between definitive chemoradiotherapy (CCRT) to the neck and upfront neck dissection followed by adjuvant CCRT. Ninety-three N3 squamous cell carcinoma head and neck cancer patients were included. Primary tumor treatment was divided to definitive CCRT (CCRT group) or curative surgery followed by adjuvant CCRT (surgery group). Neck treatment was also classified into two treatment modalities: definitive CCRT to the neck (CCRT group) or curative neck dissection followed by adjuvant CCRT (neck dissection group). Overall, the 2-year overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 51.8%, 47.3%, 45.6%, and 43.6%, respectively. In both oropharyngeal cancer and nonoropharyngeal cancer patients, in terms of OS, LRFS, RRFS or DMFS no difference was noted regarding primary tumor treatment (CCRT vs. surgery) or neck treatment (CCRT vs. neck dissection). In summary, N3 neck patients treated with definitive CCRT may achieve similar outcomes to those treated with upfront neck dissection followed by adjuvant CCRT. Caution should be made to avoid overtreatment for this group of patients.
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Affiliation(s)
- Wan-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Shih-Fan Lai
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tony Hsiang-Kuang Liang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Wei Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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5
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Carsuzaa F, Thariat J, Gorphe P, Righini C, Cosmidis A, Thureau S, Roge M, De Mones E, Servagi-Vernat S, Tonnerre D, Morinière S, Dugas A, Malard O, Pasquier F, Vergez S, Salleron J, Dufour X. Surgery or Radiotherapy of the Primary Tumor in T1-2 Head and Neck Squamous Cell Carcinoma with Resectable N3 Nodes: A Multicenter GETTEC Study. Ann Surg Oncol 2019; 26:3673-3680. [PMID: 31264120 DOI: 10.1245/s10434-019-07589-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prognosis of advanced nodal (N3) squamous cell carcinoma of the head and neck (HNSCC) is poor. We investigated whether surgery or radiotherapy of early (T1-2) primary stage HSNCC is preferable to limit the overall morbidity after upfront neck dissection (uND) for N3 disease. METHODS This retrospective multicentric Groupe d'Étude des Tumeurs de la Tête Et du Cou study included patients undergoing uND and surgery or radiotherapy of their primary. Prognostic factors were evaluated using propensity score matching to account for biases in performing surgery depending on primary site and stage. RESULTS Of 189 T1-2, N3 HNSCC patients, 70 (37.0%) underwent uND: 42 with surgery of their primary and 28 with radiotherapy only. Radiotherapy alone was more frequent in patients with hypopharyngeal primaries. All local (N = 3) and regional (N = 10) relapses (included 2 locoregional relapses) occurred within the first 2 years. There were 16 distant metastatic failures. Five-year locoregional relapse and survival incidences were 15.7% and 66.5% and were similar regardless of the treatment of the primary. The overall morbidity rate was 65.2% and was similar after weighting by the inverse propensity score (p = 0.148). The only prognostic factor for morbidity was the radicality of the uND. Prolonged parenteral feeding was not more frequent in patients only irradiated to their primary (p = 0.118). Prolonged tracheostomy was more frequent after surgery of the primary. CONCLUSIONS In patients with T1-2, N3 HNSCC undergoing uND, radiotherapy and surgery of the primary yield similar oncological outcomes. Morbidity was related to the extent of neck dissection.
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Affiliation(s)
- Florent Carsuzaa
- ENT, Service ORL, Chirurgie cervico-maxillo-faciale et audiophonologie, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France
| | | | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | | | | | | | | | | | - Denis Tonnerre
- ENT, Service ORL, Chirurgie cervico-maxillo-faciale et audiophonologie, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France
| | | | | | | | | | - Sébastien Vergez
- ENT, Institut Universitaire du Cancer de Toulouse Oncopole - CHU de Toulouse, Toulouse, France
| | - Julia Salleron
- Cellule Data Biostatistique, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Xavier Dufour
- ENT, Service ORL, Chirurgie cervico-maxillo-faciale et audiophonologie, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.
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6
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Ko HC, Chen S, Wieland AM, Yu M, Baschnagel AM, Hartig GK, Harari PM, Witek ME. Clinical outcomes for patients presenting with N3 head and neck squamous cell carcinoma: Analysis of the National Cancer Database. Head Neck 2017; 39:2159-2170. [PMID: 28737019 DOI: 10.1002/hed.24881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/31/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is a paucity of data regarding head and neck squamous cell carcinomas (HNSCCs) and N3 nodal disease. METHODS Retrospective analysis of patients with N3 HNSCC identified in the National Cancer Database (NCDB) was performed. RESULTS We identified 4867 patients with N3 HNSCC treated with primary surgery or chemoradiotherapy (CRT). Propensity-adjusted median survival was 54.2 and 44.8 months for surgery and CRT, respectively (P = .06). Oropharyngeal primary subsite demonstrated a survival advantage with surgery versus CRT with propensity-adjusted median survivals of 86.0 and 61.9 months, respectively (P < .05). CONCLUSION Management of N3 HNSCC relies largely on CRT. Patients with N3 nodal disease with nonoropharyngeal primary tumors exhibit 5-year overall survival approaching 30% independent of initial treatment modality. Patients with oropharyngeal primaries exhibit improved outcomes with surgery largely influenced by the human papillomavirus (HPV)-negative subset. These data represent the most comprehensive analysis of N3 HNSCC outcomes and serves as a foundation for future research and clinical management.
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Affiliation(s)
- Huaising C Ko
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Shuai Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Wieland
- Department of Surgery, Division of Otolaryngology and Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew M Baschnagel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory K Hartig
- Department of Surgery, Division of Otolaryngology and Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew E Witek
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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7
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Outcomes for patients with head and neck squamous cell carcinoma presenting with N3 nodal disease. CANCERS OF THE HEAD & NECK 2017. [PMID: 29527332 PMCID: PMC5844268 DOI: 10.1186/s41199-017-0027-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The present study evaluated clinical outcomes for patients with head and neck squamous cell carcinoma presenting with N3 nodal disease. Methods A retrospective analysis of N3 head and neck squamous cell carcinoma patients was performed. Pearson chi-square and Wilcoxon signed-rank tests were used to analyze patient demographics, disease characteristics, and treatment variables. Survival was evaluated using Kaplan-Meier curves with the log-rank test. Univariate analysis using Cox proportional hazards models was used to define factors associated with overall survival. Patient and tumor characteristics associated with treatment assignments were analyzed by univariate multinomial logistic regression. Results We identified 36 patients with radiographically-defined N3 disease. For the entire cohort, median follow-up was 23.6 (range 2.8–135.0) months, and overall survival was 60% at 2 years and 30% at 5 years. Overall survival was similar between patients receiving primary surgery, radiotherapy, or chemoradiotherapy (p = 0.10). Primary, regional, and distant control at 5 years was 71%, 66%, and 53%, respectively. There was a trend towards improved regional control with primary surgery (p = 0.07). Planned neck dissection following primary chemoradiotherapy did not improve regional control (p = 0.55). Patients with p16-positive tumors exhibited improved overall (p = 0.05) and metastatic recurrence-free survival (p < 0.05). There were no factors predictive of treatment assignment nor factors associated with overall survival, local and regional control, or distant metastases free-survival on univariate analysis. Conclusions Patients with N3 head and neck squamous cell carcinoma exhibit 5-year overall survival rates of approximately 30% regardless of treatment modality. Planned neck dissection does not improve regional control in patients undergoing definitive chemoradiotherapy. p16-positive patients represent a favorable cohort. Distant failure comprises the major failure pattern and should be the focus of future studies in improving the outcome of this patient cohort.
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8
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Zenga J, Haughey BH, Jackson RS, Adkins DR, Aranake-Chrisinger J, Bhatt N, Gay HA, Kallogjeri D, Martin EJ, Moore EJ, Paniello RC, Rich JT, Thorstad WL, Nussenbaum B. Outcomes of surgically treated human papillomavirus-related oropharyngeal squamous cell carcinoma with N3 disease. Laryngoscope 2016; 127:2033-2037. [PMID: 28008626 DOI: 10.1002/lary.26455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
- Head and Neck Surgery Center of Florida; Celebration Hospital, Celebration; Florida U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Douglas R. Adkins
- Department of Medical Oncology; Washington University; St. Louis Missouri U.S.A
| | | | - Neel Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Hiram A. Gay
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
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Factors that affect PERCIST-defined test-retest comparability: an exploration of feasibility in routine clinical practice. Clin Nucl Med 2016. [PMID: 26222536 PMCID: PMC4890817 DOI: 10.1097/rlu.0000000000000943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to evaluate the factors affecting the comparability of F-FDG PET/CT scans using the PERSIST criteria for treatment response evaluation in a clinical PET/CT unit. PATIENTS AND METHODS Patients diagnosed with esophageal cancer were assessed for treatment response by comparing 2 F-FDG PET/CT scans, at baseline (PET 1) and 1 month after the end of induction chemoradiation (PET 2). According to the PERCIST recommendations, patients with mean SUV normalized by the lean body mass within reference volume of interest that changed less than 0.3 unit and less than 20% were deemed as comparable. Absolute differences of body weight, blood glucose level, activity of F-FDG, and uptake time between the 2 scans were computed. Binary logistic regression was used to identify the predictive factors, and receiver operating characteristic curves were used for thresholds. P < 0.05 was considered statistically significant. RESULTS Sixty-nine subjects were identified. The mean (SD) values at PET 0 and PET 2 were 5.9 (1.04) mmol/L and 6.2 (1.06) mmol/L (P = 0.013), 54.6 (10.0 kg) and 53.3 (10.3 kg) (P = 0.013), 7.7 (1.3 mCi) and 7.6 (1.5 mCi) (P = 0.349), as well as 74.2 (12.4) minutes and 73.0 (12.3) minutes (P = 0.539), for blood glucose level, body weight, injected activity, and uptake time, respectively. Seventeen (24.6%) failed to match the PERCIST-defined comparability criteria. Case-based discrepancies (mean [SD]) were 0.76 (0.62) mmol/L, 3.4 (2.9) kg, 0.8 (0.7) mCi, and 11.7 (9.8) minutes for blood glucose, body weight, injected activity, and uptake time, respectively, of which only uptake time significantly affected comparability (P = 0.046; odds ratio, 1.06; 95% confidence interval, 1.00-1.12), with a limit of 2.2-minute discrepancy identified as the requirement for 100% comparability. CONCLUSIONS Uptake time had the strongest effect on PERCIST-defined comparability. Therefore, for response assessment scans, reference to initial scans for determination of optimal uptake time is recommended.
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10
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Up-front neck dissection followed by definitive (chemo)-radiotherapy in head and neck squamous cell carcinoma: Rationale, complications, toxicity rates, and oncological outcomes – A systematic review. Radiother Oncol 2016; 119:185-93. [DOI: 10.1016/j.radonc.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/05/2016] [Accepted: 03/02/2016] [Indexed: 12/25/2022]
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Abstract
Radiation therapy plays a central and continuously evolving role in the treatment of head and neck cancer. In this review, some basic principles of radiation oncology are explained and common clinical scenarios are addressed in which radiation therapy forms part of the treatment course, with a focus on issues most pertinent to the interaction of radiation oncology with surgical treatment. These issues include refinement of the indications guiding the choice of adjuvant radiation therapy or chemoradiotherapy, sequencing and timing of therapies before or after definitive surgical management, and scientific and technical advances with the potential to reduce radiation-related toxicity.
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Affiliation(s)
- Sue S Yom
- Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, Box 1708, 1600 Divisadero Street, MZ Building R H1031, San Francisco, CA 94143-1708, USA.
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12
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Nishikawa D, Hanai N, Ozawa T, Hirakawa H, Suzuki H, Nakashima T, Hasegawa Y. Role of induction chemotherapy for N3 head and neck squamous cell carcinoma. Auris Nasus Larynx 2014; 42:150-5. [PMID: 25498333 DOI: 10.1016/j.anl.2014.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 10/05/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The treatment of head and neck squamous cell carcinoma (HNSCC) with N3 (>6cm) lymph nodes remains difficult, and the best treatment strategy has not been elucidated. The aim of this study was to evaluate the outcomes of various treatment modalities. METHODS Sixty-nine patients with HNSCC and N3 neck disease treated with definitive therapy in our institute between 1987 and 2013 were included in the analysis. We compared the clinical outcomes of radiotherapy (RT) alone, chemoradiotherapy (CRT) and surgery with or without induction chemotherapy (ICT). RESULTS The overall survival (OS) at three years for the patients with N3 neck disease was 41%. The three-year OS rates of patients treated with definitive surgery and definitive CRT were 41% and 48%, respectively. There were no significant differences between these two treatments (P=0.82). The OS of patients who received ICT followed by definitive therapy was significantly better than that of patients who did not (P<0.001). The most common recurrence pattern was distant metastases. The rate of distant metastases was 61% of all treatment failures (20/33). CONCLUSION The high rate of distant metastases in patients with N3 neck disease suggests that prevention of distant metastases can improve survival. Based on this study, we consider that ICT may play an important role in the treatment of N3 neck disease.
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Affiliation(s)
- Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Taijiro Ozawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Hitoshi Hirakawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Tsutomu Nakashima
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
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Marklund L, Lundberg B, Hammarstedt-Nordenvall L. Management of the neck in node-positive tonsillar cancer. Acta Otolaryngol 2014; 134:1094-100. [PMID: 25220730 DOI: 10.3109/00016489.2014.920516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Neck dissection (ND) may not be warranted for those patients with complete response in the neck. Human papillomavirus (HPV)-positive or -negative tumour does not affect this recommendation. OBJECTIVES Treatment of tonsillar cancer varies considerably worldwide, although non-surgical treatment, e.g. radiotherapy (RT), possibly combined with chemotherapy (CRT), is gradually coming to be regarded as the first line of therapy. However, the optimal treatment of nodal disease remains controversial, and the fundamental question is if and when to perform ND. METHODS We performed a retrospective analysis of all patients with tonsillar cancer treated in the Stockholm area between 2000 and 2006. An analysis of node-positive tumours was done and the neck specimen was investigated for the presence of viable tumour cells after RT. A sub-analysis of HPV status was also carried out. RESULTS Following complete response after RT, 2% of patients showed viable cells in the neck specimen, compared with 60% in patients who did not show complete response. HPV-positive tumours had the same proportion of viable tumour cells in the neck specimen as HPV-negative tumours.
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Affiliation(s)
- Linda Marklund
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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Mada Y, Koshitsuka K, Ihara F, Ueki Y, Konno A. [The efficacy of superselective intra-arterial chemo-radiotherapy for cervical neck lymph node metastases]. ACTA ACUST UNITED AC 2014; 117:794-801. [PMID: 25102737 DOI: 10.3950/jibiinkoka.117.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report herein on 32 cases of head and neck carcinoma with cervical lymph node metastases treated by radiotherapy and concomitant intraarterial cisplatin (RADPLAT) from April 2009 to May 2013. N3 cases revealed residual disease of the cervical lymph nodes in 7/9 cases. Among the 22 patients excluding N1 and N3 cases, the pathological CR rate was 63.6%. Among the 13 patients in whom the anticancer drug was directly infused into the cervical lymph nodes, the pathological CR rate was 76.9%, whereas in the 9 patients without direct infusion of the cervical lymph nodes, the pathological CR rate was 44.4%. Therefore, we recommend the direct infusion into cervical lymph node metastases for not only N3 cases but also N2 cases if a feeding artery is identified easily. When clinical examination after RADPLAT leads to suspected residual disease, neck dissection should be adapted. If the clinical examination leads to a diagnosis of CR, we recommend a biopsy of the original cervical lymph nodes because the cases which we diagnosed as CR revealed residual disease of the cervical lymph nodes in 4/16.
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Sakashita T, Homma A, Hayashi R, Kawabata K, Yoshino K, Iwae S, Hasegawa Y, Nibu K, Kato T, Shiga K, Matsuura K, Monden N, Fujii M. The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas. Oral Oncol 2014; 50:657-61. [PMID: 24726547 DOI: 10.1016/j.oraloncology.2014.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/06/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The current study sought to assess the role of initial neck dissection (ND) for patients with node-positive oropharyngeal squamous cell carcinomas (OPSCC). METHODS The data for 202 patients with previously untreated node-positive OPSCC were gathered from 12 institutions belonging to the Head and Neck Cancer Study Group in the Japan Clinical Oncology Group. These patients were categorized into two groups, consisting of the initial ND group and the wait-and-see group, according to treatment policy. RESULTS Regional recurrence was observed in 17 of 93 patients undergoing initial ND, whereas, recurrent or persistent diseases were observed in 40 of 109 patients who did not undergo initial ND. The 4-year overall survival rates (OS) for the wait-and-see group and initial ND groups were 74.0% and 78.7%, respectively, and the 4-year regional control rates (RC) for each group were 77.6% and 84.9%. There were no significant differences in either OS or RC (p=0.3440 and p=0.2382, respectively). However, for patients with N3 disease, the 4-year OS of the initial ND group (100%) was favorable. For patients with N2a disease, the 4-year RC of the initial ND group was higher than that of the wait-and-see group statistically (100% vs 62.5%, p=0.0156). CONCLUSIONS The role of initial ND was limited in patients with node-positive OPSCC. The treatment strategy not involving initial ND is considered feasible and acceptable when nodal evaluation after definitive radiotherapy or chemoradiotherapy is applied adequately. However, it is possible that initial ND improves outcomes in patients with resectable large-volume nodal disease.
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Affiliation(s)
- Tomohiro Sakashita
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuichi Hayashi
- Division of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuyoshi Kawabata
- Department of Head and Neck Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kunitoshi Yoshino
- Department of Otolaryngology - Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Shigemichi Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Kenichi Nibu
- Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takakuni Kato
- Department of Oto-Rhino-Laryngology, Jikei University School of Medicine, Sendai, Japan
| | - Kiyoto Shiga
- Department of Otolaryngology - Head and Neck Surgery, Iwate Medical University Hospital, Morioka, Japan
| | - Kazuto Matsuura
- Division of Head and Neck Surgery, Miyagi Cancer Center, Sendai, Japan
| | - Nobuya Monden
- Department of Otorhinolaryngology - Head and Neck Surgery, National Shikoku Cancer Center, Matsuyama, Japan
| | - Masato Fujii
- Department of Otorhinolaryngology, National Tokyo Medical Center, Tokyo, Japan
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Adams G, Porceddu SV, Pryor DI, Panizza B, Foote M, Rowan A, Burmeister B. Outcomes after primary chemoradiotherapy for N3 (>6 cm) head and neck squamous cell carcinoma after an FDG-PET--guided neck management policy. Head Neck 2013; 36:1200-6. [PMID: 23893554 DOI: 10.1002/hed.23434] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/09/2013] [Accepted: 07/04/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess whether a positron emission tomography (PET)-directed policy remains appropriate for managing neck nodes (N3; >6 cm) in head and neck squamous cell carcinoma (HNSCC). METHODS All patients with N3 (>6 cm) HNSCC treated with definitive chemoradiotherapy (CRT) at our institution between 2005 and 2012 were included in the analysis. Patients underwent PET assessment before and 12 weeks after CRT. Neck dissections were performed for PET-avid residual nodal abnormalities after complete response at the primary site. Rate of isolated nodal failure (INF) was the primary outcome. RESULTS Median follow-up from diagnosis for 33 patients was 30 months (range, 6-76 months). INF occurred in 2 patients (6%) with neck dissections performed in 4 cases (12%). First failure was predominantly distant metastatic (10; 30%). CONCLUSION The rate of INF remains low when following a PET-directed neck management policy after definitive CRT for N3 (>6 cm) HNSCC.
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Affiliation(s)
- Gerard Adams
- Princess Alexandra Hospital, Head and Neck Radiation Oncology Cancer Service, Brisbane, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
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Denaro N, Russi EG, Numico G, Pazzaia T, Vitiello R, Merlano MC. The role of neck dissection after radical chemoradiation for locally advanced head and neck cancer: should we move back? Oncology 2013; 84:174-85. [PMID: 23306430 DOI: 10.1159/000346132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/19/2012] [Indexed: 01/12/2023]
Abstract
Until a few decades ago neck dissection (ND) was the standard surgical approach for node-positive tumours. Nowadays patients with locally advanced head and neck cancer can be treated with definitive chemoradiation (CRT), which includes the treatment of the neck; however, results on residual viable tumour after conservative treatment are heterogeneous and depend on initial node stage and primary treatment. Many authors accept adjuvant surgery in patients with N2-3 disease. Regardless of the results of upfront CRT, even if there is no evidence of lymph node metastases, when the risk for persistent positive neck nodes exceeds 15-20%, elective ND might be indicated. However, despite the diffusion of innovative technologies and therapies, there are controversies about both response evaluation and surgical management of initially involved neck nodes after definitive CRT and organ preservation treatment. In this paper we will analyse state of art of neck evaluation after CRT and discuss the role of ND.
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Affiliation(s)
- N Denaro
- Messina University, Messina, Italy.
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Karakaya E, Yetmen O, Oksuz DC, Dyker KE, Coyle C, Sen M, Prestwich RJ. Outcomes following chemoradiotherapy for N3 head and neck squamous cell carcinoma without a planned neck dissection. Oral Oncol 2013; 49:55-9. [DOI: 10.1016/j.oraloncology.2012.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 11/26/2022]
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Chan JYK, Sanguineti G, Richmon JD, Marur S, Gourin CG, Koch W, Chung CH, Quon H, Bishop JA, Aygun N, Agrawal N. Retrospective review of positron emission tomography with contrast-enhanced computed tomography in the posttreatment setting in human papillomavirus-associated oropharyngeal carcinoma. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 2012; 138:1040-6. [PMID: 23165378 PMCID: PMC3715070 DOI: 10.1001/jamaoto.2013.607] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the value of positron emission tomography (PET) with contrast-enhanced computed tomography (CT) in assessing the need for neck dissection by retrospectively reviewing the pathology reports of patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC). DESIGN Retrospective cohort study. SETTING Tertiary medical center. PATIENTS Seventy-seven patients with HPV-related SCC. MAIN OUTCOME MEASURES Seventy-seven consecutive patients with a diagnosis of HPV-related SCC who were treated with radiotherapy as the primary treatment between August 2007 and October 2010 were retrospectively evaluated for radiologic and pathologic rate of persistence of nodal metastasis after completion of definitive radiotherapy. Pretreatment and posttreatment imaging included contrast-enhanced CT and PET. Response to treatment was measured on CT, PET at standardized uptake value (SUV) thresholds of 2 and 2.5, and PET/CT by a neuroradiologist in a blinded fashion. Then, the pathology report of the patients who underwent neck dissections was reviewed for nodal status after resection and correlated with the imaging findings. RESULTS Of the 77 patients, 67 met the study criteria, with an average follow-up PET/CT scan at 90.5 days after completion of radiotherapy. Ten patients did not undergo follow-up PET/CT imaging. Twenty patients underwent neck dissections after completion of radiation therapy. Of these 20 patients, 4 had persistent tumor and 16 did not have viable tumor. Using the final pathology report to correlate with imaging responses, CT had a negative predictive value (NPV) of 85.7% (95% CI, 48.7%-97.4%), PET with SUV thresholds of 2 had an NPV of 91.7% (95% CI, 64.6%-98.5%), PET with a cutoff SUV of 2.5 had an NPV of 85.7% (95% CI, 60.1%-96.0%), PET/CT with an SUV of 2 had an NPV of 100% (95% CI, 59.8%-100.0%), and PET/CT with an SUV of 2.5 had an NPV of 85.7% (95% CI, 48.7%-97.4%). The 47 patients who did not undergo neck dissection had a median follow-up of 26 months without an isolated neck failure. Analysis of all 67 patients in the cohort revealed the following values: CT had an NPV of 95.7% (95% CI, 85.8%-98.8%), PET with an SUV of 2 had an NPV of 98.2% (95% CI, 90.4%-99.7%), PET with an SUV of 2.5 had an NPV of 95.0% (95% CI, 86.3%-98.3%), PET/CT with an SUV of 2 had an NPV of 100.0% (95% CI, 92.0%-100.0%), and PET/CT with an SUV of 2.5 had an NPV of 95.7% (95% CI, 85.8%-98.8%). CONCLUSIONS Positron emission tomography combined with contrast-enhanced CT has a better NPV than either imaging modality alone in patients with HPV-associated oropharyngeal SCC. Furthermore, PET/CT with an SUV threshold of 2 used in patients with HPV-related SCC offers an imaging modality with a high NPV that may obviate the need for unnecessary neck dissections.
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Hsing CY, Liu SA, Wang CC. Management of unknown primary head and neck squamous cell carcinoma. Am J Otolaryngol 2012; 33:637-8; author reply 638-9. [PMID: 22361343 DOI: 10.1016/j.amjoto.2012.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 12/16/2011] [Accepted: 01/12/2012] [Indexed: 10/28/2022]
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Díaz-Molina JP, Rodrigo JP, Álvarez-Marcos C, Blay P, de la Rúa Á, Estrada E, Alonso R. Resultados oncológicos y funcionales del tratamiento no quirúrgico comparado con el quirúrgico en los carcinomas epidermoides de orofaringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:348-54. [DOI: 10.1016/j.otorri.2012.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
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Díaz-Molina JP, Rodrigo JP, Álvarez-Marcos C, Blay P, de la Rúa Á, Estrada E, Alonso R. Functional and Oncological Results of Non-surgical vs Surgical Treatment in Squamous Cell Carcinomas of the Oropharynx. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.otoeng.2012.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mitsudo K, Koizumi T, Iida M, Iwai T, Oguri S, Yamamoto N, Itoh Y, Kioi M, Hirota M, Tohnai I. Thermochemoradiation therapy using superselective intra-arterial infusion via superficial temporal and occipital arteries for oral cancer with N3 cervical lymph node metastases. Int J Radiat Oncol Biol Phys 2012; 83:e639-45. [PMID: 22543212 DOI: 10.1016/j.ijrobp.2012.02.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 02/29/2012] [Accepted: 02/29/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the therapeutic results and histopathological effects of treatment with thermochemoradiation therapy using superselective intra-arterial infusion via the superficial temporal and occipital arteries for N3 cervical lymph node metastases of advanced oral cancer. METHODS AND MATERIALS Between April 2005 and September 2010, 9 patients with N3 cervical lymph node metastases of oral squamous cell carcinoma underwent thermochemoradiation therapy using superselective intra-arterial infusion with docetaxel (DOC) and cisplatin (CDDP). Treatment consisted of hyperthermia (2-8 sessions), superselective intra-arterial infusions (DOC, total 40-60 mg/m(2); CDDP, total 100-150 mg/m(2)) and daily concurrent radiation therapy (total, 40-60 Gy) for 4-6 weeks. RESULTS Six of 9 patients underwent neck dissection 5-8 weeks after treatment. In four of these 6 patients, all metastatic lymph nodes, including those at N3, were grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) tumors, as classified by the system by Shimosato et al (Shimosato et al Jpn J Clin Oncol 1971;1:19-35). In 2 of these 6 patients, the metastatic lymph nodes were grade 2b (destruction of tumor structures with a small amount of residual viable tumor cells). The other 3 patients did not undergo neck dissection due to distant metastasis after completion of thermochemoradiation therapy (n=2) and refusal (n=1). The patient who refused neck dissection underwent biopsy of the N3 lymph node and primary sites and showed grade 3 cancer. During follow-up, 5 patients were alive without disease, and 4 patients died due to pulmonary metastasis (n=3) and noncancer-related causes (n=1). Five-year survival and locoregional control rates were 51% and 88%, respectively. CONCLUSIONS Thermochemoradiation therapy using intra-arterial infusion provided good histopathologic effects and locoregional control rates in patients with N3 metastatic lymph nodes. However, patients with N3 metastatic lymph nodes experienced a high rate of distant metastases.
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Affiliation(s)
- Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
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Bisase B, Kerawala C, Skilbeck C, Spencer C. Current practice in management of the neck after chemoradiotherapy for patients with locally advanced oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg 2012; 51:14-8. [PMID: 22464179 DOI: 10.1016/j.bjoms.2012.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
Patients whose necks respond completely to chemoradiation are unlikely to have residual viable tumour, which questions the need for planned neck dissection. Partial responders often need further assessment. Positron emission tomography/computed tomography (PET/CT) is becoming the standard method of assessing the response of both the primary site and neck to chemoradiation. There is debate, however, about the timing of assessment, the best imaging technique, and the extent of neck dissection, and emerging evidence supports more selective procedures with their attendant reductions in morbidity. Various trials have tried to settle these controversies, but we hypothesised that current practice varies across the United Kingdom (UK), so we set out to establish what it is. A total of 219 questionnaires were sent to head and neck surgeons of varying disciplines and their oncology counterparts, which outlined a clinical picture of a patient with persistent nodal disease after chemoradiotherapy, and requested information about the respondents' preferred choice and timing of investigations in addition to the type of neck dissection, if indicated. There were noticeable variations in practice, with a tendency towards personal choice rather than a multidisciplinary approach. Although there were some items of broad agreement, there was disparity about the timing of imaging and operation. There is inconsistency in the management of the neck in these patients in the UK, which may reflect an absence of guidelines and paucity of evidence-based information. We need to unify practice to improve the care of patients.
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Affiliation(s)
- Brian Bisase
- Royal Marsden Hospital, Fulham Road, London, United Kingdom.
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The role of neck dissection in the setting of chemoradiation therapy for head and neck squamous cell carcinoma with advanced neck disease. Oral Oncol 2012; 48:203-10. [DOI: 10.1016/j.oraloncology.2011.10.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 10/18/2011] [Accepted: 10/19/2011] [Indexed: 11/23/2022]
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Paximadis PA, Christensen ME, Dyson G, Kamdar DP, Sukari A, Lin HS, Yoo GH, Kim HE. Up-front neck dissection followed by concurrent chemoradiation in patients with regionally advanced head and neck cancer. Head Neck 2012; 34:1798-803. [PMID: 22307819 DOI: 10.1002/hed.22011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2011] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The appropriate management of the neck in patients with regionally advanced head and neck cancer remains controversial. The purpose of this study was to retrospectively analyze our institutional experience with up-front neck dissection followed by definitive chemoradiotherapy. METHODS Fifty-five patients with radiographic evidence of large or necrotic lymph nodes underwent up-front neck dissection followed by definitive chemoradiation. RESULTS The 5-year overall survival (OS) and progression-free survival (PFS) rates were estimated at 71.3% and 64.7%, respectively. There were 2 failures in the dissected neck, for a control rate of 96.7%. There were 7 locoregional failures and 12 distant failures, for locoregional and distant control rates of 87.3% and 78.2%, respectively. CONCLUSION Up-front neck dissection followed by chemoradiotherapy resulted in excellent locoregional control, OS, and PFS. Utilization of this strategy should be considered in carefully selected patients with regionally advanced head and neck cancer. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
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Affiliation(s)
- Peter A Paximadis
- Department of Radiation Oncology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.
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Soltys SG, Choi CYH, Fee WE, Pinto HA, Le QT. A planned neck dissection is not necessary in all patients with N2-3 head-and-neck cancer after sequential chemoradiotherapy. Int J Radiat Oncol Biol Phys 2011; 83:994-9. [PMID: 22137026 DOI: 10.1016/j.ijrobp.2011.07.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/13/2011] [Accepted: 07/29/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess the role of a planned neck dissection (PND) after sequential chemoradiotherapy for patients with head-and-neck cancer with N2-N3 nodal disease. METHODS AND MATERIALS We reviewed 90 patients with N2-N3 head-and-neck squamous cell carcinoma treated between 1991 and 2001 on two sequential chemoradiotherapy protocols. All patients received induction and concurrent chemotherapy with cisplatin and 5-fluorocuracil, with or without tirapazamine. Patients with less than a clinical complete response (cCR) in the neck proceeded to a PND after chemoradiation. The primary endpoint was nodal response. Clinical outcomes and patterns of failure were analyzed. RESULTS The median follow-up durations for living and all patients were 8.3 years (range, 1.5-16.3 year) and 5.4 years (range, 0.6-16.3 years), respectively. Of the 48 patients with nodal cCR whose necks were observed, 5 patients had neck failures as a component of their recurrence [neck and primary (n = 2); neck, primary, and distant (n = 1); neck only (n = 1); neck and distant (n = 1)]. Therefore, PND may have benefited only 2 patients (4%) [neck only failure (n = 1); neck and distant failure (n = 1)]. The pathologic complete response (pCR) rate for those with a clinical partial response (cPR) undergoing PND (n = 30) was 53%. The 5-year neck control rates after cCR, cPR→pCR, and cPR→pPR were 90%, 93%, and 78%, respectively (p = 0.36). The 5-year disease-free survival rates for the cCR, cPR→pCR, and cPR→pPR groups were 53%, 75%, and 42%, respectively (p = 0.04). CONCLUSION In our series, patients with N2-N3 neck disease achieving a cCR in the neck, PND would have benefited only 4% and, therefore, is not recommended. Patients with a cPR should be treated with PND. Residual tumor in the PND specimens was associated with poor outcomes; therefore, aggressive therapy is recommended. Studies using novel imaging modalities are needed to better assess treatment response.
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Affiliation(s)
- Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA 94305-5847, USA.
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Smyth JK, Deal AM, Huang B, Weissler M, Zanation A, Shores C. Outcomes of head and neck squamous cell carcinoma patients with N3 neck disease treated primarily with chemoradiation versus surgical resection. Laryngoscope 2011; 121:1881-7. [DOI: 10.1002/lary.21968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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