Low risk of contralateral lymph node recurrence in lateralized head and neck carcinoma after postoperative ipsilateral radiotherapy

Wirtz, Mirja M.; Temming, Susanne; Köcher, Martin; Kunze, Sabine; Semrau, R.

doi:10.1007/s00066-019-01556-0

Cited by 12 publications

(14 citation statements)

References 25 publications

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“…Vergeer et al investigated 123 patients with oral cavity cancer (85%) and oropharyngeal cancer without contralateral neck irradiation and reported a cRF rate of 5.7% 18 ; however, their group included 7% of patients with close/cross midline disease, which could possibly increase the cRF. Wirtz et al reported a cRF rate of 6.1%, mainly in the oropharynx (52.8%), with extended data for oral cavity (38%) and hypopharynx (10%) 12 ; however, 73.1% of their patients received contralateral neck dissection, which could have been an overtreatment. Another phase II study demonstrated a low cRF rate of 2.8% for resected head and neck cancers.…”

Section: Discussionmentioning

confidence: 99%

Low-Risk Contralateral Neck Failure for Lateralized Oral Cancer with Locally Advanced Stage and Effects of Neck Irradiation

Cheng

Lin

Tsai

et al. 2022

Preprint

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To investigate the incidence of the contralateral neck failure (cRF) rate and outcomes among patients with well-lateralized locally advanced oral cavity squamous cell carcinoma (OSCC) with/without ipsilateral or bilateral neck adjuvant irradiation. Total 149 patients with lateralized OSCC who have undergone curative surgery with pathologically proven pT3/4 or pN0-2b between 2007–2017 were retrospectively enrolled. Those with cross midline, neck-level 1a involvement, and positive extra-nodal extension (ENE) were excluded. The median follow-up time was 5.2 years (range, 2.91–7.83). Pathological stages T3 and T4 were 22.7% and 56.8%, respectively. Pathologically negative and positive lymph nodes were 61.4% and 38.6%, respectively. The cumulative incidence of 5-year cRF rate was 3.57% (95% CI, 1.3–7.7%). No significant differences in the 5-year CSS, LRRFS, DMFS, and cRRFS were observed among those undergoing unilateral and bilateral neck irradiation. Five patients (3.4%) had contralateral neck recurrence, all simultaneously with local recurrence. No isolated contralateral neck recurrence was identified. In conclusion, the cRF rate was acceptably low in patients with well-lateralized advanced OSCC with the initially uninvolved contralateral neck. Omitting contralateral neck irradiation with active surveillance could be safely considered without compromising the cure rate in such locally advanced OSCC patients.

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Section: Discussionmentioning

confidence: 99%

Low-Risk Contralateral Neck Failure for Lateralized Oral Cancer with Locally Advanced Stage and Effects of Neck Irradiation

Cheng

Lin

Tsai

et al. 2022

Preprint

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“…To confirm these claims, prospective studies with follow-up of IMT, stenosis, and cerebrovascular events are needed to enable interventional trials for effective prevention (e.g. antiplatelet drugs, statins, H 2 S) [36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Screening for irradiation vasculopathy by intima-media thickness sonography in head and neck cancer patients

Strüder

Hellwig

Rennau

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Post-irradiation vasculopathy is a severe form of atherosclerosis and affects the prognosis of head and neck cancer survivors. Sonographic intima-media thickness (IMT) precedes stenosis, plaque formation, and cerebrovascular events. Therefore, IMT may be a valuable screening marker for post-irradiation toxicity. However, the critical irradiation dose and the onset of IMT increase remain unclear. Methods The cross-sectional study analysed the carotid artery IMT in 96 irradiated patients and 41 controls regarding irradiation dose, post-irradiation-interval, and cardiovascular risk factors. Distinct irradiation doses to the tumour side and the contralateral hemineck enabled detection of dose depended effects within one patient and control of risk factors. Results Radiotherapy caused a dose-dependent increase in IMT. The toxicity did not have saturation effects for > 60 Gy. The IMT increase occurred in short-term following radiotherapy and the risk for a pathological value (> 0.9 mm) rose significantly. The correlation between IMT and radiotherapy was comparable to established cardiovascular risk factors. Conclusion Radiotherapists should consider the additional toxicity of high doses for non-metastatic head and neck cancer. If neck metastases require radiotherapy with boost, IMT measurement is suitable for early detection of carotid artery damage.

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“…In advanced-stage disease, i.e., UICC tumour stages III and IV, the combined therapeutical approach consisting of neck dissection followed by adjuvant radiation/chemoradiation is highly recommended as it yields the most favourable oncological outcomes [ 10 , 11 , 12 , 13 , 14 ]. In contrast, for early stage disease, i.e., UICC tumour stages I and II, the most effective therapy, i.e., ipsilateral selective neck dissection followed by radiation therapy or chemoradiation and primary radiation/chemoradiation therapy, is still under debate [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

Rupp

Mantsopoulos

Sievert

et al. 2022

JCM

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Background: This study on patients with head and neck cancer of unknown primary (HNCUP) assesses the impact of surgical and non-surgical treatment modalities and the tumour biology on the oncological outcome. Methods: A total of 80 patients with HNCUP (UICC I–IV) were treated with simultaneous neck dissection followed by adjuvant therapy, between 1 January 2007 and 31 March 2020. As the primary objective, the influence of treatment modalities on the overall survival (OS), the disease-specific survival (DSS) and the progression-free survival (PFS) were analysed in terms of cox regression and recursive partitioning. The tumour biology served as secondary objectives. Results: The 5-year OS for the entire cohort was 67.7%, (95% CI: 54.2–81.2%), the 5-year DSS was 82.3% (72.1–92.5%) and the 5-year PFS was 72.8% (61.8–83.8%). Cox regression revealed that patients undergoing adjuvant radiotherapy only had a four times higher risk to die compared to patients receiving chemoradiation therapy (HR = 4.45 (1.40; 14.17), p = 0.012). The development of distant metastases had a significantly negative impact on OS (HR = 8.24 (3.21–21.15), p < 0.001) and DSS (HR = 23.79 (6.32–89.56), p < 0.001). Recursive portioning underlined the negative influence of distant metastases on OS (3.2-fold increase in death probability) and DSS (4.3-fold increase in death probability), while an UICC stage of IVb increased the risk for further progression of the disease by a factor of 2. Conclusions: The presence of distant metastases as well as adjuvant treatment with radiation without concomitant chemotherapy, were among others, significant predictors for the overall survival of HNCUP patients, with distant metastases being the most significant predictor.

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Low risk of contralateral lymph node recurrence in lateralized head and neck carcinoma after postoperative ipsilateral radiotherapy

Cited by 12 publications

References 25 publications

Low-Risk Contralateral Neck Failure for Lateralized Oral Cancer with Locally Advanced Stage and Effects of Neck Irradiation

Low-Risk Contralateral Neck Failure for Lateralized Oral Cancer with Locally Advanced Stage and Effects of Neck Irradiation

Screening for irradiation vasculopathy by intima-media thickness sonography in head and neck cancer patients

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

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