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Crompton DJ, Mohammadi H, Pirgousis P, Patel S, Janus J, Zhao Y, McGee LA, Patel SH, Routman DM, Ma DJ, Holtzman AL. Elective Irradiation of Retropharyngeal Lymph Nodes as an Indication for Adjuvant Radiation Therapy After Transoral Surgery for Tonsil Cancer. Pract Radiat Oncol 2024; 14:452-456. [PMID: 38750933 DOI: 10.1016/j.prro.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024]
Abstract
Treatment of squamous cell carcinoma of the tonsil involves primary radiation therapy (RT) or surgical resection. Historically, if RT was the primary or adjuvant treatment modality, most of the bilateral retropharyngeal lymph nodes (RPLNs) were treated electively with a therapeutic dose for subclinical disease, regardless of whether radiographically pathologic lymph nodes were seen on initial diagnostic imaging. De-escalation strategies include the incorporation of transoral surgery with the goal to either eliminate or reduce the dose of adjuvant RT or chemotherapy. Transoral surgery does not include elective removal of the RPLNs, and no guideline or outcome paper recommends adjuvant RT specifically to electively treat RPLNs. In this Topic Discussion, we discuss pertinent literature and suggest management decisions. The management decisions discussed in this Topic Discussion pertain to only tonsillar primaries and not those of the soft palate or base of the tongue.
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Affiliation(s)
- David J Crompton
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | - Homan Mohammadi
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | - Phillip Pirgousis
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville, Florida
| | - Samip Patel
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville, Florida
| | - Jeffery Janus
- Department of Otolaryngology, Mayo Clinic Florida, Jacksonville, Florida
| | - Yujie Zhao
- Department of Medical Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida.
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Wang T, Wang J, Li Q, Li Y, Song X. Incidence and patterns of lymph node metastases in head and neck rhabdomyosarcoma: One-institution study. Head Neck 2024. [PMID: 39004953 DOI: 10.1002/hed.27870] [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: 03/19/2024] [Revised: 06/18/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Head and neck rhabdomyosarcoma (HNRMS) is an aggressive malignant soft tissue tumor that easily develops lymph node metastasis (LNM) and distant metastasis. No literature investigates the pattern of LNM in HNRMS. METHODS Ninety-five consecutive patients with HNRMS newly diagnosed at one institution between November 2011 and July 2023 were retrospectively reviewed. All the patients underwent head and neck contrast-enhanced MRI and/or CT, PET-CT if necessary. The associations between LNMs and clinical characteristics and histopathological parameters were discovered. RESULTS 44.2% of patients had evidence of LNM at diagnosis, and the most common LNM occurred in the ipsilateral retropharyngeal space. The primary tumor metastasizes to the retropharyngeal space, and then next to level II is the most common LN drainage basin. In multivariate analysis, only distant metastasis determines the prognosis, other than LN status. CONCLUSIONS LNM has a high incidence in HNRMS and rarely causes contralateral metastasis for localized lesions or skip metastasis.
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Affiliation(s)
- Tian Wang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
| | - Jie Wang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
| | - Qiang Li
- Department of Otorhinolaryngology, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Li
- Department of Oncology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Xinmao Song
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai, China
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Tzelnick S, Tsai J, Hosni A, Goldstein DP, de Almeida JR, Yao CMKL. A Comparison of Transoral Versus Transcervical Surgical Approaches to Retropharyngeal Lymphadenectomy: A Scoping Review. J Otolaryngol Head Neck Surg 2024; 53:19160216241265092. [PMID: 39077912 PMCID: PMC11289808 DOI: 10.1177/19160216241265092] [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: 01/21/2024] [Accepted: 04/21/2024] [Indexed: 07/31/2024] Open
Abstract
IMPORTANCE A gap in knowledge exists concerning the functional outcomes and complications when comparing various surgical approaches for retropharyngeal lymph node (RPLN) metastases. OBJECTIVE To explore perioperative outcomes, functional outcomes, and complications associated in the treatment of RPLN metastases. DESIGN The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the PubMed and Scopus databases. REVIEW METHODS We systematically searched 2 databases from inception to January 2023 for articles examining the treatment approaches and postoperative outcomes in the retropharyngeal space. We included English records about surgical approaches, complications, functional outcomes for patients >18 years old with retropharyngeal lymphadenopathy. RESULTS One-hundred ninety-nine articles were identified, of which 17 were included in the analysis. Three studies assessed RPLN dissection in the postradiation setting. We identified limited knowledge about functional outcomes and complications following surgery for retropharyngeal lymphadenopathy. Overall, acute postoperative dysphagia was documented in 35/170 patients (20.5%). However, the assessment of dysphagia was limited, and not described in the majority of studies. The overall rate of postoperative neuropathy and hematoma were 4.1% and 4.7%, respectively. No postoperative hematomas were documented in the transcervical approach. CONCLUSION Our findings underscore the need for further research on postoperative outcomes following RPLN dissection. We recommend further studies focusing on objective swallow assessments and long-term outcomes of either surgical approaches.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - Jillian Tsai
- Department of Radiation Oncology, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - David P. Goldstein
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - John R. de Almeida
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
| | - Christopher M. K. L. Yao
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, Princess Margaret Cancer Center—University Health Network, Toronto, ON, Canada
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Cho KH, Honkura Y, Kim JH, Hayashi S, Kitamura K, Murakami G, Rodríguez-Vázquez JF. Topohistology of the cranial nerves IX-XII at the cranial base and upper parapharyngeal space: A histological study using human fetuses. Anat Rec (Hoboken) 2023. [PMID: 38009864 DOI: 10.1002/ar.25355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/17/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
The topographical relationships among the lower cranial nerves, internal carotid artery (ICA), and internal jugular vein (IJV) in the upper parapharyngeal neurovascular bundle remain obscure. Thus, details of the anatomy were examined in human fetus histology. We observed the horizontal histological sections from 20 midterm (9-18 weeks) and 12 near-term (28-40 weeks) fetuses. At the external skull base, the glossopharyngeal nerve crosses the anterior aspect of the IJV to reach the medially located Hyrtl's fissure in the petrous temporal bone. The nerve crossed the anterior aspect of the ICA medially near or below the first cervical nerve root. Below the hypoglossal nerve canal, the accessory nerve crosses the anterior or posterior aspects of the IJV and moves laterally. During the half-spiral course, the hypoglossal nerve was tightly attached to the posterolateral-anterior aspects of the vagus nerve and surrounded by a common nerve sheath. The glossopharyngeal ganglia sometimes extended inferiorly to the level of the hypoglossal nerve canal but were absent along the inferior course. The inferior vagal ganglion rarely extends above the occipital condyle. The superior cervical sympathetic ganglion occasionally extends above the first cervical nerve root. The IJV (or ICA) descends to the lateral (or medial) margins of the parapharyngeal neurovascular bundle. The glossopharyngeal (or accessory) nerve crosses the ICA (or IJV) to exit the bundle at the base of the skull (or below the hypoglossal nerve canal). The glossopharyngeal and vagus inferior ganglia differ at each site.
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Affiliation(s)
- Kwang Ho Cho
- Department of Neurology, Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Yohei Honkura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, Tokyo, Japan
| | - Kei Kitamura
- Department of Histology and Embryology, Tokyo Dental College, Tokyo, Japan
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
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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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Lavigne D, De-Meric-de-Bellefon M, Nguyen-Tan FP, Landry D, Létourneau-Guillon L, Bélair M, O'Sullivan B, Filion E, Bahig H. Incidence and predictive factors of retropharyngeal lymph node metastases in patients with oropharyngeal cancer undergoing multimodality treatment planning imaging. Head Neck 2023; 45:1530-1538. [PMID: 37045788 DOI: 10.1002/hed.27368] [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: 10/08/2022] [Revised: 02/24/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND We investigated the incidence and predictive factors of retropharyngeal lymph node (RPLN) metastases in patients with oropharyngeal cancer (OPC) undergoing multimodality treatment planning imaging before radiotherapy. METHODS Consecutive patients with OPC treated with curative-intent radiotherapy from 2017 to 2019 were retrospectively analyzed. Treatment planning comprised contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) unless contraindicated. RESULTS Of 300 patients, 66 (22%) had radiological evidence of RPLN involvement on planning images, compared to 17 (6%) on diagnostic CT alone. On multivariate analysis, RPLN involvement was statistically (p < 0.05) associated with tonsil, soft palate, and posterior pharyngeal wall primaries, and with disease extension to the soft palate or vallecula. CONCLUSIONS Multimodality treatment planning imaging reveals a high rate of RPLN metastases from OPC compared to diagnostic CT alone. Patients with tonsil, soft palate, or posterior pharyngeal wall primaries or disease extending to the soft palate or vallecula appear at higher risk.
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Affiliation(s)
- Danny Lavigne
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | | | - Felix-Phuc Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - David Landry
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Laurent Létourneau-Guillon
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Manon Bélair
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
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Ansinelli H, Gay C, Nguyen S, Morrison CM, Robbins JR. Personalized precision radiotherapy and its evolving role for human papillomavirus-positive oropharyngeal cancer. JOURNAL OF THE NATIONAL CANCER CENTER 2023; 3:72-82. [PMID: 39036313 PMCID: PMC11256722 DOI: 10.1016/j.jncc.2022.11.006] [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: 08/15/2022] [Revised: 10/19/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022] Open
Abstract
Human papilloma virus (HPV)-associated oropharyngeal cancer (OPC) is a unique entity with increased responsiveness to treatment and excellent oncologic outcomes. The purpose of this narrative review is to highlight how an improved prognosis for HPV (+) tumors and an ever-increasing understanding of the risk factors, risk stratification, and areas of potential spread are shaping management options. Additionally, we aim to detail how advances in treatment technology on both the surgical and radiation fronts are facilitating the delivery of increasingly personalized and precise treatments. This review will describe key aspects of recent and currently-ongoing trials investigating the de-escalation and individualization of treatment in this patient cohort, and how they are building a foundation for distinct treatment paradigms for HPV (+) tumors. Further studies into the integration of biomarker-guided treatments combined with clinical trial enrollment will help ensure a future of personalized treatments and improved outcomes, both in terms of oncologic outcomes and toxicity, for patients with HPV (+) OPC.
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Affiliation(s)
- Hayden Ansinelli
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Chris Gay
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Steven Nguyen
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Christopher M. Morrison
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Jared R. Robbins
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
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Toya R, Saito T, Fukugawa Y, Matsuyama T, Matsumoto T, Shiraishi S, Murakami D, Orita Y, Hirai T, Oya N. Prevalence and risk factors of retro-styloid lymph node metastasis in oropharyngeal carcinoma. Ann Med 2022; 54:436-441. [PMID: 35098812 PMCID: PMC8812754 DOI: 10.1080/07853890.2022.2031270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Supporting data defining the selection criteria of level VIIb for inclusion in the target volume in radiotherapy (RT) planning are insufficient. We evaluated the prevalence of level VIIb retro-styloid lymph node metastasis (RSLNM) and associated risk factors in patients with oropharyngeal carcinoma (OPC). MATERIALS AND METHODS We retrospectively reviewed pre-treatment [18F]-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography (CT) along with contrast-enhanced thin slice CT and magnetic resonance (MR) images of 137 patients pathologically confirmed as having OPC who underwent RT. The location of lymph nodes (LNs) was confirmed on the planning CT images. Fisher's exact test and logistic regression analyses were made to determine the risk factors of RSLNM. RESULTS RSLNM was confirmed in 18 (13%) patients. All RSLNMs were located within level VIIb on the planning CT images. No patients exhibited LNM in contralateral level VIIb. Furthermore, no patients with negative or single ipsilateral cervical LNM had RSLNM. Fisher's exact test revealed that smoking status (p=.027), multiple ipsilateral cervical LNM (p=.045) and LN ≥15 mm in the upper limit of ipsilateral level II (p<.001) were significantly associated with RSLNM. Logistic regression analyses revealed that the presence of LNs ≥15 mm in upper limit of ipsilateral level II was significantly associated with RSLNM (odds ratio: 977.297; 95% confidence interval: 57.629-16573.308; p<.001). CONCLUSIONS RSLNM is relatively common in patients with OPC with a prevalence rate of approximately 10%. The prevalence of RSLNM in patients with negative or single ipsilateral cervical LNM and contralateral RSLNM is extremely low; therefore, level VIIb can be excluded from the target volume in such patients. LN ≥15 mm in the upper limit of ipsilateral level II is a risk factor for RSLNM. Ipsilateral level VIIb should be included in the target volume for patients with this risk factor.KEY MESSAGERetro-styloid lymph node metastasis (RSLNM) prevalence is ∼10% in oropharyngeal carcinoma.Lymph node ≥15 mm in ipsilateral level II upper limit is a risk factor for RSLNM.
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Affiliation(s)
- Ryo Toya
- 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
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tadashi Matsumoto
- 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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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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Garas G, Roland NJ, Lancaster J, Zammit M, Manon VA, Davies K, Jones TM, De M, Holsinger FC, Prestwich RJD, Fleming JC. Novel Strategies for Managing Retropharyngeal Lymph Node Metastases in Head and Neck and Thyroid Cancer with Transoral Robotic Surgery (TORS). Ann Surg Oncol 2022; 29:7881-7890. [PMID: 35842533 DOI: 10.1245/s10434-022-12208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/01/2022] [Indexed: 12/18/2022]
Abstract
Retropharyngeal metastases are encountered in a variety of head and neck malignancies, imposing significant surgical challenges owing to their distinct location and proximity to neurovascular structures. Radiotherapy is the recommended treatment in most cases owing to its oncological efficacy. However, retropharyngeal irradiation affects the superior pharyngeal constrictor muscles and parotid glands, with the potential for long-term dysphagia and xerostomia. A younger oropharyngeal and thyroid cancer patient demographic is trending, fueling interest in treatment de-escalation strategies. Consequently, reducing radiotoxicity and its long-term effects is of special relevance in modern head and neck oncology practice. Through its unique ability to safely extirpate these traditionally difficult-to-access retropharyngeal lymph nodes via a natural orifice, TransOral Robotic Surgery (TORS) can considerably lower the surgical morbidity of retropharyngeal lymph node dissection (RPLND), compared with current existing approaches. This review summarizes the latest developments in the field, exposing current research gaps and discusses specific clinical settings where TORS could enable treatment de-escalation. In early-stage node-negative oropharyngeal cancer, single-modality surgical treatment with TORS RPLND may improve risk stratification of metastasis and recurrence in this region. TORS RPLND is also a potentially viable treatment option in salvage of an isolated retropharyngeal node recurrence or in the primary setting of a thyroid malignancy with a single positive retropharyngeal node. In time, TORS RPLND may provide an alternative de-escalation strategy in these three scenarios. However, with the reported morbidities, further prospective trials with long-term follow-up data are required to prove oncological safety and functional benefits over existing strategies.
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Affiliation(s)
- George Garas
- Head and Neck Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK.
| | - Nick J Roland
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Zammit
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Victoria A Manon
- Department of Oral and Maxillofacial Surgery, The University of Texas at Houston, Houston, TX, USA
| | - Katharine Davies
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Terry M Jones
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mriganka De
- Head and Neck Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Floyd C Holsinger
- Department of Otorhinolaryngology and Head and Neck Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Robin J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jason C Fleming
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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11
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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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12
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An C, Sun Y, Miao S, Yu X, Zhang Y, Zhang X, Xia L, Liu S, Li Z, Yi J. Retropharyngeal Lymph Node Metastasis Diagnosed by Magnetic Resonance Imaging in Hypopharyngeal Carcinoma: A Retrospective Analysis From Chinese Multi-Center Data. Front Oncol 2021; 11:649540. [PMID: 34178636 PMCID: PMC8226130 DOI: 10.3389/fonc.2021.649540] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background To assess the prevalence, risk factors and prognostic significance of retropharyngeal lymph node (RPLN) metastasis diagnosed by magnetic resonance imaging (MRI) in patients with hypopharyngeal squamous cell carcinoma (HPSCC). Methods 259 patients from three cancer institutions in China from Jan 2010 to Dec 2018 were analyzed, retrospectively. All the patients had been given pre-treatment magnetic resonance imaging (MRI) of head and neck and were then treated with definitive radiotherapy with or without chemotherapy. Pretreatment diagnostic MRIs were reviewed by a dedicated head and neck radiologist, for the presence or absence of radiographically positive RPLN, cervical LN and tumor invasion.Demographic variables were analysed by descriptive statistics using SPSS 20.0. Predictors of the presence of RPLN and its prognostic significance were examined. Results RPLN metastasis was discovered in 44 patients (17%). Logistic analysis showed that posterior pharyngeal wall (PPW) primary tumor; PPW invasion; N2-3; multiple cervical lymph node (LN) involvement (>2 LNs) were associated with RPLN metastasis, with metastasis rates 37%, 30%, 31% and 33% respectively. Patients with RPLN metastasis had a significantly reduced 5-year overall survival (OS) and disease-free survival (DFS) compared to the non-RPLN metastasis group (OS 28% vs. 48%, p=0.001; DFS 25% vs. 41%, p=0.040). Conclusions RPLN metastasis was not uncommon in HPSCC patients. Risk factors were: PPW primary tumor, PPW invasion and cervical LN status. RPLN metastasis is a poor prognosticator for survival.
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Affiliation(s)
- Changming An
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Susheng Miao
- Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiaoduo Yu
- Departments of Radiation, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Departments of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiwei Zhang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lili Xia
- Xinxiang Medical University, Xinxiang, China
| | - Shaoyan Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengjiang Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Departments of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Hirshoren N, Weinberger JM. Surgical Perspective on Sentinel Node Biopsy for Operable T1-T2N0 Oral and Oropharyngeal Cancer. J Clin Oncol 2021; 39:1598-1599. [PMID: 33705202 DOI: 10.1200/jco.20.03300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nir Hirshoren
- Nir Hirshoren, MD, and Jeffrey M. Weinberger, MD, Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Jeffrey M Weinberger
- Nir Hirshoren, MD, and Jeffrey M. Weinberger, MD, Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
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14
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Bauwens L, Baltres A, Fiani DJ, Zrounba P, Buiret G, Fleury B, Benzerdjeb N, Grégoire V. Prevalence and distribution of cervical lymph node metastases in HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma. Radiother Oncol 2021; 157:122-129. [PMID: 33545255 DOI: 10.1016/j.radonc.2021.01.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In oropharyngeal squamous cell carcinoma (OP-SCC), the prevalence and distribution of clinical and pathological lymph node metastasis in the neck have been extensively reported. It served as the basis for consensus recommendations on the selection of the lymph node levels in the neck requiring a treatment. The objective of the study is to compare the prevalence and distribution of neck node metastases in HPV+ and HPV- OP-SCC from a large series of patients with OP-SCC who underwent a cervical lymph-node dissection (LND) as part of their treatment. METHODS The study concentrated on OP-SCC patients treated by various neck node dissection (LND) procedures from January 2014 to December 2018 in 3 French institutions. Patients with prior head and neck cancer, prior neck surgery, the use of induction chemotherapy, or patients with carcinoma of unknown primary were excluded. HPV-status was assessed by p16 immunohistochemistry. For each patient, the clinical and the pathological nodal status, as well as the distribution of the positive nodes in each neck level (from Ia to V) were reported. RESULTS Two-hundred and sixty-three patients were included (126 p16-negative (p16-), and 137 p16-positive (p16+). The rate of clinical positive node (cN+) reached 54% and 88.3% in the p16- and p16+ groups, respectively (p < 0.001); the corresponding rate of pathological positive node (pN+) reached 61.9% and 91.2%, respectively (p < 0.001). Regarding the clinical lymph node distribution, in p16+ patients, more positive nodes were observed in the ipsilateral level IV (p = 0.003), and less positive nodes were observed in the contralateral levels III and IV (p = 0.003 and p = 0.045, respectively). Regarding the pathologic lymph node distribution in the ipsilateral neck, in the cN0 patients, no significant difference was observed between p16- and p16+ patients (p = 0.33 to 1); in the cN+ patients, the nodes were distributed in levels Ib, II, III, IV and V without differences between the p16- and the p16+ patients. In the contralateral neck of p16- patients, nodes metastases were mainly observed in levels II, III and IV, whereas for the p16+ patients, positive nodes were only observed in level II (p = 0.03). CONCLUSION This study demonstrated the higher prevalence of cN+ and pN+ in p16+ OP-SCC patients, but without meaningful difference in the distribution of the lymph node drainage between p16- and p16+ OP-SCC. It indicates that no difference should be made between p16- and p16+ patients regarding the extend of neck treatment.
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Affiliation(s)
| | - Aline Baltres
- Pathology Department, Centre Léon Bérard, Lyon, France
| | | | | | - Guillaume Buiret
- Surgical Department, Centre Hospitalier de Valence, Valence, France
| | - Bertrand Fleury
- Radiation Oncology Department, Centre Marie Curie, Valence, France
| | - Nazim Benzerdjeb
- Pathology Department, Centre Hopsitalier Lyon Sud, Pierre-Bénite, France
| | - Vincent Grégoire
- Radiation Oncology Department, Centre Léon Bérard, Lyon, France.
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15
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Panda S, Thakar A, Kakkar A, Kumar R, Seenu V, Singh CA, Sharma SC. Is the retropharyngeal lymph node the first echelon node for carcinoma tonsil? Prospective evaluation and literature review. Eur Arch Otorhinolaryngol 2021; 278:3995-4004. [PMID: 33417147 DOI: 10.1007/s00405-020-06585-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Tonsil cancer being predominantly treated by non-surgical means, there is a paucity of data on lymph nodal drainage pathways and histo-pathologically confirmed metastatic rates. This study assesses the retropharyngeal lymph node (RPLN) in N0 squamous cell carcinoma tonsil as a possible first echelon node and a site for occult metastasis. METHODS Prospective study involving treatment naïve N0 carcinoma tonsil treated by primary surgery and adjuvant treatment from June 2017 to March 2019. In-vivo lymph nodal drainage patterns were assessed by sentinel node mapping by preoperative SPECT-CT and intra-operative hand-held Gamma probe. All patients had a subsequent Level I-III/IV sampling neck dissection supplemented with RPLN dissection. Histological evaluation of sentinel nodes and RPLN involved step-serial sectioning and pan-cytokeratin immunohistochemistry. A comprehensive literature review was performed with keywords "retropharyngeal lymph node", "oropharynx", "tonsil", "squamous cell carcinoma" to determine the incidence of RPLN positivity in previously published series. RESULTS Sentinel node was successfully identified by SPECT-CT in all 17 patients (ipsilateral level 2a-13/17, 2b-1/17, 3-1/17; bilateral 2a-1/17; isolated contralateral retropharyngeal node-1/17). 8/17 had occult neck metastasis. In no patient was an ipsilateral RPLN identified as the sentinel node. Histological sampling did not indicate metastatic tumor in the RPLN in any patient (0/17). A systematic literature review further confirmed that RPLN metastasis in oropharyngeal cancer is noted only in the presence of pN + disease at other neck levels, and isolated RPLN metastasis is extremely rare (1.2%). CONCLUSION The ipsilateral RPLN is not identified either as the first echelon node or as a site of occult metastatic disease in N0 tonsil cancer. CTRI REGISTRATION CTRI/2019/06/019551.
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Affiliation(s)
- Smriti Panda
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, Ansari Nagar East, New Delhi, 110029, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, Ansari Nagar East, New Delhi, 110029, India.
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - V Seenu
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, Ansari Nagar East, New Delhi, 110029, India
| | - Suresh C Sharma
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, Ansari Nagar East, New Delhi, 110029, India
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16
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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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17
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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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