PET‐CT Staging of the Neck in Cancers of the Oropharynx: Patterns of Regional and Retropharyngeal Nodal Metastasis

Tauzin, Marcie; Hagan, Joseph; Wood, Charles; Ferris, Robert L.; Walvekar, Rohan R.

doi:10.1002/lary.21650

Cited by 13 publications

(19 citation statements)

References 15 publications

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“…Tang et al 5 studied a cohort of 165 patients with OPC, 134 of whom had HPV-associated disease, and observed a 12% incidence of RPLN involvement, similar to the 9% incidence observed in the current study cohort and the 10% incidence observed in our 2013 study, although lower than the incidence of 16% to 21% reported by others. 3,[14][15][16] The discrepancy in the RPLN incidences reported in these study populations compared with that in the current study may be related to differences in the percentage of patients with locally advanced OPC in each study cohort. For example, the percentage of patients with T3-T4 disease in the referenced studies ranged from 46% to 64%, which is higher than the rate of 42% observed in the study by Tang et al 5 and the rate of 28% (224 of 796 patients) observed in the current study.…”

Section: Discussioncontrasting

confidence: 73%

“…However, within the context of other variables, the potential relationship between RPLN and outcomes may be difficult to demonstrate. Tang et al studied a cohort of 165 patients with OPC, 134 of whom had HPV‐associated disease, and observed a 12% incidence of RPLN involvement, similar to the 9% incidence observed in the current study cohort and the 10% incidence observed in our 2013 study, although lower than the incidence of 16% to 21% reported by others . The discrepancy in the RPLN incidences reported in these study populations compared with that in the current study may be related to differences in the percentage of patients with locally advanced OPC in each study cohort.…”

Section: Discussionsupporting

confidence: 65%

See 1 more Smart Citation

Radiographic retropharyngeal lymph node involvement in HPV‐associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes

Lin

Garden

Elhalawani

et al. 2019

Cancer

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Background The objective of the current study was to characterize the incidence, pattern, and impact on oncologic outcomes of retropharyngeal lymph node (RPLN) involvement in HPV‐associated oropharyngeal cancer (OPC). Methods Data regarding patients with HPV‐associated OPC who were treated at The University of Texas MD Anderson Cancer Center with intensity‐modulated radiotherapy from 2004 through 2013 were analyzed retrospectively. RPLN status was determined by reviewing pretreatment imaging and/or reports. Outcomes analysis was restricted to patients with lymph node‐positive (+) disease. Kaplan‐Meier survival estimates were generated and survival curves were compared using the log‐rank test. Bayesian information criterion assessed model performance changes with the addition of RPLN status to current American Joint Committee on Cancer staging. Competing risk analysis compared modes of disease recurrence. Results The incidence of radiographic RPLN involvement was 9% (73 of 796 patients) and was found to vary by primary tumor site. The 5‐year rates of freedom from distant metastases (FDM) and overall survival were lower in patients with RPLN(+) status compared with those with RPLN‐negative (‐) status (84% vs 93% [P = .0327] and 74% vs 87% [P = .0078], respectively). RPLN(+) status was not found to be associated with outcomes on multivariate analysis. Bayesian information criterion analysis demonstrated that current American Joint Committee on Cancer staging was not improved with the inclusion of RPLN. Locoregional and distant disease recurrence probabilities for those patients with RPLN(+) status were 8% and 13%, respectively, compared with 10% and 6%, respectively, for those with RPLN(‐) status. RPLN(+) status portended worse 5‐year FDM in the low‐risk subgroup (smoking history of <10 pack‐years) and among patients who received concurrent chemotherapy but not induction chemotherapy. Conclusions RPLN(+) status was associated with worse overall survival and FDM on univariate but not multivariate analysis. In subgroup analyses, RPLN(+) status was associated with poorer FDM in both patients with a smoking history of <10 pack‐years and those who received concurrent chemotherapy, suggesting that RPLN(+) status could be considered an exclusion criteria in treatment deintensification efforts seeking to omit chemotherapy.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionsupporting

confidence: 65%

Radiographic retropharyngeal lymph node involvement in HPV‐associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes

Lin

Garden

Elhalawani

et al. 2019

Cancer

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“…Despite the RPLN group being described as a nodal bed at risk for spread from oropharyngeal cancer (OPC), there are only a few reports in the medical literature that have documented the incidence of RPLN involvement in OPC, and among these, the impact of RPLN involvement on oncologic outcomes has been ambiguous . Because clinical RPLN involvement from OPC is a reportedly infrequent occurrence, and because RPLNs are neither readily amenable to direct clinical examination nor included in routine neck dissections, a large modern cohort of OPC patients with long‐term follow‐up initially staged with advanced imaging modalities inclusive of the skull base is necessary to accurately estimate both the incidence of clinical/radiographic RPLN involvement and subsequent impact on clinically relevant oncologic outcomes with sufficient power.…”

Section: Introductionmentioning

confidence: 99%

The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer

Gunn

Debnam

Fuller

et al. 2013

Cancer

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Background We carried out this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, which have not been well established to date. Methods Our departmental database was queried for patients irradiated for OPC from 2001–2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcomes data were retrieved and analyzed. Results The cohort consisted of 981 patients. Median follow up was 69 months. The base of tongue (47%) and tonsil (46%) were the most common primary sites. The majority of patients had T1-2 primaries (64%) and 94% stage 3-4B disease. IMRT was used in 77%, and systemic therapy was delivered to 58%. The incidence of radiographic RPLN involvement was 10% and highest for pharyngeal wall (23%) and lowest for base of tongue tumors (6%). RPLN adenopathy correlated with a number of patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (p <.001 for all): local control (79% vs. 92%), nodal control (80% vs. 93%), recurrence-free (51% vs. 81%), distant metastases-free (66% vs. 89%), and overall survival (52% vs. 82%), and maintained significance for local control (p=.023), recurrence-free (p=.001), distant metastases-free (p=.003), and overall survival (p=.001) on multivariate analysis. Conclusions In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.

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“…Surgical management of the neck in patients with pharyngeal cancers does not usually involve a dissection of the retropharyngeal lymph node (RPLNs). Neck dissections do not routinely address RPLNs, creating a potential for recurrence in the retropharynx and the need to address this nodal basin with radiotherapy (Tauzin, et al, 2010). Treatment of the neck in patients with clinical evidence of nodal metastasis has traditionally been surgical.…”

Section: General Principlesmentioning

confidence: 99%