Benefit of postoperative radiotherapy for early tumors with single ipsilateral lymph node metastasis

Abstract

Objectives/Hypothesis Indication for postoperative radiotherapy in patients with locally circumscribed tumors (pT1–pT2) and a single ipsilateral lymph node metastasis (pN1) is debatable. The aim of this study was to evaluate the oncological long‐term outcome of patients with pT1‐pT2 pN1 squamous cell carcinoma (SCC) of the oral cavity, the oropharynx, and the hypopharynx without extracapsular spread (ECS) after a margin‐negative surgical resection, who either received or did not receive postoperative (chemo)radiotherapy. Study Design Retrospective case series. Methods The oncological outcome of patients with pT1‐pT2 pN1 SCC without ECS was evaluated retrospectively. All patients underwent primary tumor resection that included transoral laser microsurgery and neck dissection at an academic tertiary referral center. Results Of 65 identified patients treated between 1986 and 2015 (18 oral cavity, 30 oropharynx, 17 hypopharynx), 21 (32%) received postoperative radiotherapy, and 44 (68%) were treated by surgery alone. The group of patients receiving postoperative treatment showed a significantly superior 5‐year disease‐specific (94.4% vs. 73.2%, P = .029) and recurrence‐free survival (85.2% vs. 43.2%, P = .002), as well as a higher local control rate (90.2% vs. 64.9%, P = .042). The overall survival was 71.4% vs. 62.6% (P = .53). The mean follow‐up was 80.7 months. Conclusions Patients with locally circumscribed carcinomas and a single ipsilateral ECS‐negative lymph node metastasis seem to benefit from postoperative radiotherapy. Level of Evidence 4 Laryngoscope, 130:E530–E538, 2020

Prognostic analysis and establishment of a nomogram in patients with myoepithelial carcinoma of the salivary gland: A population‐based study

“…Radiotherapy is also an important treatment regimen. 14 Postoperative radiotherapy was used to decrease the risk of recurrence; however, radiotherapy could not significantly reduce the recurrence rate of myoepithelial carcinoma. In Yu et al's study, 8 of the 12 patients who underwent postoperative radiotherapy had recurrence.…”

The role of postoperative radiotherapy in pN1 oral cavity cancer without extranodal extension

“…For example, Weiss et al compared the 5-year OS, DSS, and recurrence-free survival in pN1 OSCC patients without ENE. However, in that study, the case number was limited, as only 18 OSCC pN1 patients were investigated, including 4 who received PORT and 14 who received surgery alone [ 29 ]. On the contrary, various endpoints were measured in different studies; however, neck recurrence rate, an important outcome for evaluating the benefit of PORT, was rarely reported in these prior studies.…”

The Benefit of Postoperative Radiotherapy and Extending Neck Dissection in pT1-2 Oral Squamous Cell Carcinoma With a Single Ipsilateral Cervical Lymph Node Metastasis (pN1)

“…In an effort to provide a sufficient answer and an evidencebased recommendation for the relatively rare case of pT1-2 pN1 situation, several retrospective studies have been carried out (8)(9)(10)(11)(12)(13)(14). Among the relatively inhomogeneous studies, including different adverse pathological features, competing risk factors and patients' characteristics, publications analyzing the US National Cancer Database have drawn attention, mainly because of the large number of patients included in the analyses (15)(16)(17).…”