Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection

McMullen, Caitlin; Garneau, Jonathan; Weimar, Emillie; Ali, Sana; Farinhas, Joaquim M.; Yu, Eugene; Som, Peter M.; Sarta, Catherine; Goldstein, David P.; Su, Susie; Xu, Wei; Smith, Richard V.; Miles, Brett A.; Almeida, John R. de

doi:10.1016/j.oraloncology.2019.04.017

Cited by 18 publications

(16 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Certainly, surgery is not without sequelae; it is notable that 22.2% of patients reported issues related to neck dissection, although many were in the radiated groups. In contrast to our study design, recent data indicate that bilateral neck dissection is likely not warranted in this population [57].…”

Section: Discussionmentioning

confidence: 60%

De-Escalated Adjuvant Therapy After Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Carcinoma: The Sinai Robotic Surgery (SIRS) Trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Treatment of human papillomavirus‐related oropharyngeal squamous cell carcinoma (HPVOPC) results in unprecedented high survival rates but possibly unnecessary toxicity. We hypothesized that upfront surgery and neck dissection followed by reduced‐dose adjuvant therapy for early and intermediate HPVOPC would ultimately result in equivalent progression‐free survival (PFS) and overall survival while reducing toxicity. Methods This study was a nonrandomized phase II trial for early‐stage HPVOPC treated with transoral robotic surgery (TORS) followed by reduced‐dose radiotherapy. Patients with previously untreated p16‐positive HPVOPC and <20 pack years’ smoking history were enrolled. After robotic surgery, patients were assigned to group 1 (no poor risk features; surveillance), group 2 (intermediate pathologic risk factors [perineural invasion, lymphovascular invasion]; 50‐Gy radiotherapy), or group 3 (poor prognostic pathologic factors [extranodal extension [ENE], more than three positive lymph nodes and positive margin]; concurrent 56‐Gy chemoradiotherapy with weekly cisplatin). Results Fifty‐four patients were evaluable; there were 25 in group 1, 15 in group 2, and 14 in group 3. Median follow‐up was 43.9 months (9.6–75.8). Disease‐specific survival was 98.1%, and PFS was 90.7%. PFS probability via Kaplan‐Meier was 91.3% for group 1, 86.7% for group 2, and 93.3% for group 3. There were five locoregional failures (LRFs), including one distant metastasis and one contralateral second primary. Average time to LRF was 18.9 months (9.6–59.0); four LRFs were successfully salvaged, and the patients remain disease free (11.0–42.7 months); one subject remains alive with disease. Conclusion The results indicate that upfront surgery with neck dissection with reduced‐dose radiation for T1–2, N1 stage (by the eighth edition American Joint Committee on Cancer staging manual) HPVOPC results in favorable survival with excellent function in this population. These results support radiation dose reduction after TORS as a de‐escalation strategy in HPVOPC. Implications for Practice Transoral robotic surgery can provide a safe platform for de‐escalation in carefully selected patients with early‐stage human papillomavirus‐related oropharyngeal cancer. In this clinical trial, disease‐specific survival was 100%, over 90% of the cohort had a reduction of therapy from standard of care with excellent functional results, and the five patients with observed locoregional failures were successfully salvaged.

show abstract

Section: Discussionmentioning

confidence: 60%

De-Escalated Adjuvant Therapy After Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Carcinoma: The Sinai Robotic Surgery (SIRS) Trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patients with clinical T3/T4 disease, not to mention clinical N3 disease, are known to have higher rates of pCND 7,14‐16 . Nevertheless, their data, along with that of other retrospective series, 17 provide additional evidence in favor of risk stratification for HPV‐associated base of tongue primary tumors.…”

Section: Discussionmentioning

confidence: 96%

Redefining risk of contralateral cervical nodal disease in early stage oropharyngeal cancer in the human papillomavirus era

et al. 2021

View full text Add to dashboard Cite

Background The optimal extent of surgery and/or radiation to the contralateral lymph node region is unknown in early‐stage human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC). Methods To investigate the pathologic incidence of and risk factors for contralateral nodal disease (CND) in cT1‐T2 HPV‐related OPSCC treated with transoral robotic surgery (TORS) and bilateral neck dissection (BND), the records of 120 patients were reviewed. Results Eleven patients displayed pathologic contralateral nodal disease (pCND), including 7.1% of tonsil and 10.9% of base of tongue (BOT) cases. Medial hemistructure involvement and cN2 disease were significantly associated with pCND. Zero cN0 patients had pCND, and on multivariate analysis only cN classification remained significantly associated with pCND. Four percent of BOT patients and 2% of tonsil patients with a well‐lateralized primary and cN0/N1 neck demonstrated pCND. Conclusions HPV‐related OPSCC that are cN0‐N1 have exceedingly low rates of pCND. Well‐lateralized HPV‐related BOT primaries with limited clinical nodal disease may be candidates for ipsilateral only treatment.

show abstract

“…Although previous studies reported the rate of occult contralateral LN metastasis and its prognostic significance in p16+ OPSCC, its clinical relevance has not been established. Therefore, multicenter studies with larger sample sizes are required for further confirmation, and these findings should be taken into consideration when planning treatment for p16+ OPSCC …”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Lymph Node Status in p16+ Oropharyngeal Cancer After Surgical Treatment

Park

Koh

et al. 2020

The Laryngoscope

View full text Add to dashboard Cite

Objectives/Hypothesis In this study, we retrospectively reviewed medical records of patients who underwent surgery for p16+ oropharyngeal cancer and analyzed the prognostic implications of pathologic lymph node (LN) status, including number of metastatic LNs, LN ratio, and location of metastatic LNs. Study Design Retrospective case series. Methods We retrospectively reviewed data on patients diagnosed with p16+ oropharyngeal cancer. Results The study population consisted of 159 males and 29 females with a mean age of 57.2 years. The primary tumor sites were tonsils (n = 160), base of the tongue (n = 24), and soft palate (n = 4). Only recurrence‐free survival (RFS) showed a significant correlation with contralateral LN metastasis on multivariate analysis. On Kaplan‐Meier analysis, 5‐year RFS was 92.4% in patients without contralateral LN metastasis and 68.8% in patients with contralateral LN metastasis. Conclusions Among pathologic LN status in p16+ oropharyngeal cancer, only contralateral LN metastasis showed prognostic significance in disease recurrence of p16+ oropharyngeal squamous cell carcinoma patients. Level of Evidence 4 Laryngoscope, 130: 1973–1979, 2020

show abstract

Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection

Cited by 18 publications

References 21 publications

De-Escalated Adjuvant Therapy After Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Carcinoma: The Sinai Robotic Surgery (SIRS) Trial

De-Escalated Adjuvant Therapy After Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Carcinoma: The Sinai Robotic Surgery (SIRS) Trial

Redefining risk of contralateral cervical nodal disease in early stage oropharyngeal cancer in the human papillomavirus era

Prognostic Significance of Lymph Node Status in p16+ Oropharyngeal Cancer After Surgical Treatment

Contact Info

Product

Resources

About