Oncologic outcomes of selective neck dissection in HPV‐related oropharyngeal squamous cell carcinoma

Zenga, Joseph; Graboyes, Evan M.; Sinha, Parul; Lindberg, Michael; Martin, Eliot J.; Ma, Daniel; Thorstad, Wade L.; Rich, Jason T.; Moore, Eric J.; Haughey, Bruce H.

doi:10.1002/lary.26272

Cited by 26 publications

(29 citation statements)

References 51 publications

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“…Different characteristics were analyzed to find possible predictors for LRC, DFS, or OS: age, gender, initial performance status, site (oropharyngeal tumor relative to all the other sites), histology, tumor‐node‐metastasis stage, induction chemotherapy (yes/no), concomitant chemotherapy (no, cisplatin, cetuximab), fractionation, and overall treatment time. We acknowledge the importance of human papillomavirus for oropharyngeal cancer in consideration of recent literature . However, due the percentage of patients with unknown status treated in the past years, we decided not to include these data in our outcome analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Different characteristics were analyzed to find possible predictors for LRC, DFS, or OS: age, gender, initial performance status, site (oropharyngeal tumor relative to all the other sites), histology, tumor-node-metastasis stage, induction chemotherapy (yes/no), concomitant chemotherapy (no, We acknowledge the importance of human papillomavirus for oropharyngeal cancer in consideration of recent literature. [15][16][17] However, due the percentage of patients with unknown status treated in the past years, we decided not to include these data in our outcome analysis. Rates of LRC at 1 and 2 years were 90.1% AE 2.6% and 84.2% AE 3.4%, respectively (mean 75 AE 3 months, 95% confidence interval (CI) 69-81 months, the median survival was not reached in the patient cohort).…”

Section: Patient Outcomementioning

confidence: 99%

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Impact of hypofractionated schemes in radiotherapy for locally advanced head and neck cancer patients

et al. 2019

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Objective To analyze two cohorts of locally advanced head and neck cancer (LAHNC) patients treated with two schedules of hypofractionated radiotherapy and 5 versus 3 mm clinical target volume–planning target volume (CTV‐PTV) margins. Methods 145 patients were included. The patient cohort was divided into two groups. Group A included 97 patients treated with 69.96/54.45 grays (Gy) to the high‐risk and low‐risk volumes, respectively, in 33 fractions, with 5 mm margins. Group B included 48 patients treated with 66/54 Gy in 30 fractions using 3 mm margins. Toxicity was recorded according to the Common Toxicity Criteria version 3. Patient outcomes for locoregional control (LRC), disease‐free survival (DFS), and overall survival (OS) were determined. Results Median follow‐up was 26 months. In terms of toxicity, acute dysphagia worsened significantly (P = 0.003) in group B, whereas acute salivary toxicity tended to significance (P = 0.071). No significant late toxicity differences were recorded. Rates of LRC at 1 and 2 years were 90.1% ± 2.6% and 84.2% ± 3.4%, respectively, with superiority for group A (P = 0.045). The statistical significance remained for the low‐dose level (P = 0.007) but not for high dose (P = 0.110). Rates of DFS at 1 and 2 years were 84.9% ± 3.1% and 76.5% ± 3.9%, respectively, whereas rates of OS were 95.9% ± 1.8% and 91.6% ± 2.7%, respectively. No differences were observed between the two groups in terms of DFS (P = 0.270) and OS (P = 0.152). Conclusion The use of reduced CTV to PTV margins and dose reduction with hypofractionation schedule can improve the pattern of toxicity in LAHNC patients. This approach resulted in an increased rate of locoregional progression, particularly in low‐risk regions. Level of Evidence 4 Laryngoscope, 130:E163–E170, 2020

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Section: Resultsmentioning

confidence: 99%

“…Different characteristics were analyzed to find possible predictors for LRC, DFS, or OS: age, gender, initial performance status, site (oropharyngeal tumor relative to all the other sites), histology, tumor-node-metastasis stage, induction chemotherapy (yes/no), concomitant chemotherapy (no, We acknowledge the importance of human papillomavirus for oropharyngeal cancer in consideration of recent literature. [15][16][17] However, due the percentage of patients with unknown status treated in the past years, we decided not to include these data in our outcome analysis. Rates of LRC at 1 and 2 years were 90.1% AE 2.6% and 84.2% AE 3.4%, respectively (mean 75 AE 3 months, 95% confidence interval (CI) 69-81 months, the median survival was not reached in the patient cohort).…”

Section: Patient Outcomementioning

confidence: 99%

Impact of hypofractionated schemes in radiotherapy for locally advanced head and neck cancer patients

et al. 2019

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“…Whereas most surgeons would agree that selective neck dissection addressing levels 2 through 4 is appropriate given the known lymphatic drainage pathways from the oropharynx, the number of nodes that should be removed remains unclear. [9][10][11] There is considerable variation in lymph node yield from neck dissection for oropharyngeal cancer, and although this is likely multifactorial, there is an inherent tradeoff between extent of nodal resection and surgical risk. Fully skeletonizing the carotid sheath, floor of the neck, and inferior border of level 4 increases the risk of cranial nerve weakness, major vessel injury, cutaneous sensory deficits, and chyle leak.…”

Section: Introductionmentioning

confidence: 99%

Lymph node yield from neck dissection in HPV‐associated oropharyngeal cancer

et al. 2019

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Objectives To determine the influence of nodal yield during neck dissection on survival in surgically managed human papillomavirus (HPV)‐associated oropharyngeal cancer. Methods The National Cancer Database was used to identify patients with HPV‐associated tumor T1 to T2 oropharyngeal squamous cell carcinoma who underwent upfront surgery with or without adjuvant therapy. Patients were stratified by lymph node yield (<26 vs. ≥26 nodes). Multivariable Cox proportional hazards regression analysis was used to identify factors associated with overall survival. Models were stratified by pathologically positive node number. Results There were 2,554 patients identified with previously untreated T1 to T2 oropharyngeal squamous cell carcinoma who underwent resection of the primary tumor and neck dissection between 2010 and 2015. Fifty‐two percent had zero to one pathologically involved lymph node. Among all study patients, lymph node harvest of ≥26 was not associated with survival when adjusted for relevant covariates (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.49–1.00). However, in patients with zero to one pathologically involved node, lymph node harvest of ≥26 was significantly associated with improved overall survival (HR 0.29, 95% CI 0.20–0.78). This survival benefit was lost in patients with two or more positive nodes (2–4 positive nodes: HR 0.89, 95% CI 0.52–1.51; 5 or more positive nodes: HR 1.01, 95% CI 0.47–2.20). Conclusion For patients with surgically managed early T‐stage HPV‐associated oropharyngeal squamous cell carcinoma, lymph node yield was not associated with survival outcomes for patients with multiple positive lymph nodes. Those with a more limited burden of regional metastatic disease, however, may benefit harvest of at least 26 nodes during neck dissection. Level of Evidence 4 Laryngoscope, 130:666–671, 2020

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“…Of these, six studies reported on primary CRT [5][6][7][8][9][10] and 4 on surgery + adjuvant RT. 5,9,11,12 Five studies reported on the proportion of patients with residual nodal disease on histology after Keypoints • Management of metastatic N3 nodal disease from primary HNSCC is controversial with a recent trend towards observation of the neck following chemoradiotherapy.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Only one surgical study reported on the type of ND 11 and two studies did not report on the use of concomitant chemotherapy. 5,9 The studies on primary CRT reported local control rates for three studies of 77%-86% at 2-to 3-year follow-up ( Table 5 illustrates the studies that reported on the proportion of patients with positive histology from ND following CRT, either with a CR or non-CR to treatment.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases

Virk

Ingle

Podesta

et al. 2020

Clinical Otolaryngology

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Background: Management of metastatic N3 nodal disease from primary head and neck squamous cell carcinoma (HNSCC) is controversial. Recently, there has been a move to observation of the neck for those who achieve complete response (CR) after chemoradiotherapy (CRT). We sought to determine survival outcomes for N3 nodal disease, particularly for patients with human papilloma virus (HPV)-positive HNSCC. Methods: We carried out a systematic search of MEDLINE and Embase for articles between 01/2008 and 12/2017. Articles on N3 nodal disease in HNSCC patients treated with CRT or surgery + adjuvant RT/CRT were included if they reported on oropharyngeal or HPV+ subgroups. Local control (LC), nodal control (NC), distant metastasis-free survival (DMFS), disease-free survival (DFS) or overall survival (OS) was assessed.Results: Nine studies met the inclusion criteria. Eight of these studies (N = 5304) allowed further comparison: 4 were on CRT, 2 on surgery + RT/CRT and 2 on both.Four of these eight studies and the remaining included study reported on residual nodal disease on histology after neck dissection (ND) following CRT. Patients treated with CRT achieved LC rates of 77%-94% at 2-3 years; those who had a CR had LC of >90%. Better NC was noted in patients who achieved a CR. Three-year OS was better for HPV+ HNSCC (range, 55.2%-81%). Patients with CR had better survival outcomes (DMFS 77% at 3 years vs 69.8% for HPV+; OS 68.9% at 3 years vs 55.2% for HPV+). Primary surgery demonstrated similar survival for HPV+ vs HPV− and better survival in oropharyngeal cancers. Five-year DFS rates varied from 30% to 87%, and OS from 26.6% to 84%. For patients with non-CR, positive histology rates varied from 27.3% to 100%, with average positive histology rates of 27.3% in HPV+ patients with non-CR vs 60% for HPV− patients with non-CR. Conclusion:The current literature does not support the de-escalation of treatment with HPV− N3 disease. Observation of HPV+ patients who achieve a CR post-CRT is reasonable but further prospective studies are required given the heterogeneity and risk of bias within these current studies. Planned ND should remain standard of care for non-CR cohort.

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Oncologic outcomes of selective neck dissection in HPV‐related oropharyngeal squamous cell carcinoma

Abstract: 4. Laryngoscope, 127:623-630, 2017.

Cited by 26 publications

References 51 publications

Impact of hypofractionated schemes in radiotherapy for locally advanced head and neck cancer patients

Impact of hypofractionated schemes in radiotherapy for locally advanced head and neck cancer patients

Lymph node yield from neck dissection in HPV‐associated oropharyngeal cancer

Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases

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