PET-CT staging of the neck in cancers of the oropharynx: patterns of regional and retropharyngeal nodal metastasis

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

doi:10.1186/1477-7819-8-70

Cited by 27 publications

(15 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More recently, modern series describing the use of intensity-modulated radiation therapy (IMRT) in the treatment of head and neck cancers highlighted patterns of failure with an emphasis on the importance of adequate radiation therapy target volume delineation pertaining to RPLN target coverage to avoid additional RPLN failures. 3,4 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, [5][6][7] and among these, the impact of RPLN involvement on oncologic outcomes has been ambiguous. [8][9][10] 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

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer

Gunn

Debnam

Fuller

et al. 2013

Cancer

View full text Add to dashboard Cite

show abstract

“…14 Our radiologic criteria used to detect retropharyngeal metastasis (FDG-avid on CT/PET, enlarged (>1cm), cystic or necrotic component, evidence of extracapsular spread) are well established criteria in the literature. 15–17 .…”

Section: Discussionmentioning

confidence: 99%

Exploration for an Algorithm for Deintensification to Exclude the Retropharyngeal Site From Advanced Oropharyngeal Squamous Cell Carcinoma Treatment

Spector

Chinn

Bellile

et al. 2016

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Importance Understanding the drainage patterns to the retropharyngeal nodes is an important consideration in oropharyngeal squamous cell carcinoma (OPSCC) because treatment of these nodes is related to increased morbidity. Prediction of these drainage patterns could not only help minimize treatment morbidity, but could also prevent failures in at-risk patients, as de-escalation trials are underway for this disease. Objective To evaluate the prevalence of pathologic retropharyngeal adenopathy (RPA) in OPSCC relative to involvement of the oropharyngeal subsite, number of neck nodes, T classification and N classification. Design Retrospective review from 2003–2010 Setting Academic Referral Center Participants 205 previously untreated, advanced stage (III, IV), pathologically confirmed patients with OPSCC Exposure: Concurrent chemoradiation Main Outcome Measures Radiologic evidence of pathologic RPA was tabulated and related to involvement of the oropharyngeal subsite, number of neck nodes, T classification and N classification. Results Pathologic RPA was identified in 18% of patients. There were pathologic retropharyngeal lymph nodes in 12/89 (13%) base of tongue cancers, 24/109 (22%) tonsil cancers, and 1/7 (14%) other oropharyngeal subsite cancers. Increasing prevalence of RPA was positively correlated with closer proximity to the posterior tonsillar pillar. A multivariate predictive regression model using the oropharyngeal subsite, involvement of the posterior tonsillar pillar, number of metastatic nodes, T classification, and N classification, showed that the number of metastatic nodes was statistically significant with an odds ratio of 1.436 (p=0.0001, 95% confidence interval: 1.203 – 1.714). Conclusions and Relevance The prevalence of pathologic RPA in this cohort was 18% and patients with multiple nodes had the highest risk for pathologic RPA, followed by involvement of the posterior tonsillar pillar. However, this data suggests that there is no clear algorithm that can be used for de-intensification to exclude the retropharyngeal site from the treatment volume using extent of disease gathered from pretreatment imaging for patients with advanced stage OPSCC.

show abstract

“…The literature lacks discussion about the role of MACD. Fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT) is very effective for diagnosing cervical lymph nodal metastasis in head and neck cancer as well as in NPC [8][9][10][11]. PET/CT also facilitates accurately predicting distant metastasis by evaluating measured nodal data [12].…”

Section: Introductionmentioning

confidence: 99%