Lymph node‐positive head and neck cancer treated with definitive radiotherapy

Abstract

We investigated the prognostic impact of absolute lymphocyte count (ALC) following induction chemotherapy in newly diagnosed adult acute lymphoblastic leukemia (ALL). Patients with ALC ≥350 cells/μL at day 28 had a median overall survival (OS) of 47.4 months when compared with 17.6 months for those with an ALC <350 cells/μL (HR = 1.98, P = 0.007). Among patients who achieved a complete remission, median event‐free survival (EFS) for those with ALC ≥350 cells/μL on day 28 was 42.1 months when compared with 13.9 months in those with ALC <350 cells/μL (HR = 2.08, P = 0.006). In multivariable analysis, the ALC on day 28 (<350 cells/μL vs. ≥350 cells/μL, P ≤ .0004 for OS and EFS) along with WBC at diagnosis (≤6.0 or >30.0 K/μL vs. >6.0–30.0 K/μL, P ≤ 0.002 for OS and EFS) and cytogenetics (abnormal vs. normal, P = 0.002 for OS and P = 0.02 for EFS) were independent prognostic factors of both OS and EFS. Combining these three factors segregates patients in three well‐defined risk groups. These data suggest that ALC can be used in combination with other prognostic features to better predict outcome and that targeting the immune system to improve ALC may be a worthwhile strategy in ALL. Am. J.Hematol. © 2012 Wiley Periodicals, Inc.

Characteristics and kinetics of cervical lymph node regression after radiation therapy for human papillomavirus-associated oropharyngeal carcinoma: Quantitative image analysis of post-radiotherapy response

“…While numerous studies have proposed CT-based criteria to help guide post-RT neck evaluation and management [8, 10, 23, 24], refining such criteria is not the intent of this study, as all patients in our cohort achieved disease control with RT-based treatments alone. We believe the value of the current study is to further develop our understanding of nodal regression in HPV-associated OPCs.…”

Feasibility of Salvage Selective Neck Dissection after Primary Irradiation of Pharyngeal and Laryngeal Carcinoma

“…Yeung et al[14] documented that the risk of leaving disease in the neck if the ND is limited to the levels of residual adenopathy is only 5%. Taking this into account, if residual adenopathy is on a single level and the dissection encompasses that particular level and 1 or 2 levels distally, the expected risk of leaving behind the disease would be much lower than 5%.…”

“…With the advent of organ preservation protocols that have soared in recent years, planned ND has become less apparent and the concept of salvage ND comes into the picture. Over the past few years, multiple studies have been conducted on the role of a more targeted surgery of a selective or limited ND after primary CRT [11-14]. Recent data suggest that a more conservative approach of ND is adequate to remove metastatic neck disease with minimal morbidities but comparable oncological outcomes [2, 4, 11, 15, 16].…”

The Role of Neck Dissection after Radical Chemoradiation for Locally Advanced Head and Neck Cancer: Should We Move Back?

“…It is reported that SND, more than its timing, is associated with lower complications (SND complication <5%) [48]. The use of SND was reported as suitable after CRT also in patients with advanced regional disease.…”

“…On the one hand is the risk of neck recurrences or microscopic residual disease, on the other hand is the probability of an overtreatment with possible surgical complications (lymphedema, dysphagia, fistulae) [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72]. Benefits may include local regional control and OS [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,…”