Eliminating Postoperative Radiation to the Pathologically Node-Negative Neck: Long-Term Results of a Prospective Phase II Study

Abstract

PURPOSE The volume treated with postoperative radiation therapy (PORT) is a mediator of toxicity, and reduced volumes result in improved quality of life (QOL). In this phase II trial, treatment volumes were reduced by omitting PORT to the pathologically negative (PN0) neck in patients with primary head and neck squamous cell carcinoma. METHODS Patients with head and neck squamous cell carcinoma who underwent surgical resection and neck dissection with a PN0 neck and high-risk features mandating PORT to the primary and/or involved neck were eligible. The primary end point was greater than 90% disease control in the unirradiated neck. QOL was evaluated using the MD Anderson Dysphagia Inventory and the University of Michigan patient-reported xerostomia questionnaire. RESULTS Seventy-three patients were enrolled, and 72 were evaluable. Median age was 56 years (range, 31 to 81 years); 58 patients were male, and 47 (65%) had a smoking history. Sites included oral cavity (n = 14), oropharynx (n = 37), hypopharynx (n = 4), larynx (n = 16), and unknown primary tumor (n = 1). According to the American Joint Committee on Cancer Staging Manual (7th edition), 67 patients (93%) had stage III/IV disease, and 71% of tumors involved or crossed midline. No patient had contralateral neck PORT. In 17 patients (24%), only the primary site was treated. At a median follow-up of 53 months, two patients experienced treatment failure of the PN0 unirradiated neck; they also experienced treatment failure locally. Unirradiated neck control was 97% (95% CI, 93.4% to 100.0%). Five-year rates of local control, regional control, progression-free survival, and overall survival were 84%, 93%, 60%, and 64%, respectively. QOL measures were not significantly different from baseline at 12 and 24 months post-PORT ( P > .05). CONCLUSION Eliminating PORT to the PN0 neck resulted in excellent control rates in the unirradiated neck without long-term adverse effects on global QOL.

Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit?

“…Recent prospective data suggest that eliminating postoperative radiation to the pathologically negative neck results in excellent local control. 37 In this study, we report on oncologic as well as patientreported outcomes (PROs) in OPSCC patients who received primary TORS followed by adjuvant CRT, with a particular emphasis on the laterality of neck RT in order to potentially identify those benefitting from surgery in order to safely spare contralateral neck radiation and improve QOL outcomes in those receiving concurrent chemotherapy.…”

Preservation of Swallowing in Resected Oral Cavity Squamous Cell Carcinoma: Examining Radiation Volume Effects (PRESERVE): Study Protocol for a Randomized Phase II Trial

“…Twenty percent of patients included in the study had oral cavity tumours. 27 Taken together, the existing retrospective and prospective data suggests that omitting PORT in patients with a pN0 neck likely has a recurrence rate less than 15% -20%. However, no randomized studies have directly examined the omission of PORT in the pN0 neck.…”

Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial

“…To date, there is only one prospective study [1] with a small sample size and some retrospective studies [2,3] investigating the possibility of treating ipsilateral elective neck nodes only in the…”

“…To date, there is only one prospective study [1] with a small sample size and some retrospective studies [2,3] investigating the possibility of treating ipsilateral elective neck nodes only in the postoperative situation of head and neck cancer. Moreover, the primary tumor region usually is treated with a dose up to 64-66 Gy [4][5][6].…”