Outcomes in N3 Head and Neck Squamous Cell Carcinoma and Role of Upfront Neck Dissection

Abstract

Objectives We investigated the prognostic factor of N3 head and neck squamous cell carcinoma (HNSCC), including the role of upfront neck dissection (UFND) before radiotherapy (RT). Methods We retrospectively reviewed the charts of consecutive N3 HNSCC patients treated with curative intent RT. Results In the study, 323 N3 HNSCC patients were included. Of those, 125 patients (39%) had UFND. Median follow‐up was 3.9 years (0–14.8 years). Overall survival (OS) at 5 years was 31.2%, and progression‐free survival (PFS) was 26%. In the multivariate analysis, OS was improved in PS 0, T1‐2 tumors, patients receiving concurrent chemotherapy, never or former smokers, and UFND. UFND was strongly associated with increased OS (45.7% vs. 21.2%, P < .001), and PFS (P < .001). Regardless of neck node size, UFND improved survival (P = .001 for ≤ 7 cm and P = .004 for > 7 cm). Conclusion UFND could improve treatment outcomes in N3 HNSCC, especially for non‐oropharyngeal cancer, regardless of neck node size. Level of Evidence 2B Laryngoscope, 131:E844–E850, 2021

Upfront neck dissection versus concurrent chemoradiotherapy in stage T1–3N3 hypopharyngeal carcinoma: A comparative study of clinical outcomes and predictive factors

“…Furthermore, the upfront ND group showed a signi cant trend towards better DSS and OS outcomes. Carsuzaa et al [19] reported that upfront ND signi cantly improved locoregional control and Boros et al [17] reported that upfront ND could be associated with improved outcomes in non-oropharyngeal N3 HNSCC. In this study, DFS in the CRT group was slightly worse than that reported [12,17], and the results declined rapidly over two years.…”

“…Therefore, the clinical outcomes and overall prognosis of N3 cases with extranodal extension are poor [15]. One approach for improving cervical lymph node control rates is upfront neck dissection (ND) before CRT [5,16,17]. However, evidence regarding its impact on prognosis is con icting, with some studies showing improved outcomes [17,18] and others suggesting no signi cant improvements [9,19].…”

Extracapsular nodal extension and tumor deposits in head and neck squamous cell carcinoma

“…36 Performing an initial ND approach might be a strategy to control regional disease by removing necrotic or hypoxic bulky neck nodes before CTX-RT. 37 Nevertheless, regional and distant progression can still occur in these patients, suggesting that metastatic potential is intrinsic to the initial nodal stage. Furthermore, in patients with resectable N3 (AJCC 7th) disease, ND has improved locoregional control but implies surgical morbidity.…”

Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary

“…In our study, prognostic factors for locoregional relapse, PFS and HNCUP-specific death included an interval of more than 10 weeks between diagnosis and radiotherapy. In head and neck cancers, the longer the delay between initial surgery and adjuvant radiotherapy, the shorter the survival [ 28 , 29 , 30 ]. The PET-CT prognostic value for HNCUP-specific in our study probably indicated better detection of synchronous metastatic lesions [ 11 , 19 , 29 , 31 , 32 , 33 ] (and further exclusion of these patients from our studies).…”