Correlation of Computerized Tomography density patterns of lymph nodes with treatment results and outcome in head and neck cancer patients treated by 2 different chemoradiotherapy schedules

Jaju, Sweta; Gupta, Satish; Pandey, Satya Deo; Singh, Virendra

doi:10.4103/0973-1482.136566

Cited by 3 publications

(1 citation statement)

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“…Intranodal necrosis is visualized on CT as a non-enhancing hypodense area, and such necrotic areas are thought to contain less oxygen and have poorer responses to chemotherapy or radiotherapy. Some studies showed that hypodense metastatic nodes on contrast-enhanced CT had a significantly poorer response to chemotherapy or chemoradiotherapy compared to isodense metastatic nodes [11,12,23], while other studies did not [13,24]. Such inconsistent results may be attributed to the fact that not all the hypodense metastatic nodes were necrotic, as some may have been cystic nodes.…”

Section: Discussionmentioning

confidence: 99%

Cystic nodal metastasis in patients with oropharyngeal squamous cell carcinoma receiving chemoradiotherapy: Relationship with human papillomavirus status and failure patterns

et al. 2017

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ObjectivesWe investigated the relationships of cystic nodal metastasis, human papillomavirus (HPV) status, and treatment failure patterns in patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with chemoradiotherapy.MethodsWe retrospectively reviewed pretreatment MRI and clinical courses of patients with OPSCC whose tumors were tested for HPV-induced p16 expression via immunohistochemistry and who completed chemoradiotherapy. Cervical cystic nodal metastasis and necrotic nodal metastasis were classified on MRI.ResultsOf 98 patients eligible for analysis, 33 were p16-positive. Cystic nodal metastasis was significantly more prevalent in p16-positive than in p16-negative patients (39.4% versus 18.5%, respectively; p = 0.025). Necrotic nodal metastasis was significantly more prevalent in p16-negative than in p16-positive patients (73.8% versus 51.5%, respectively; p = 0.027). On multivariate analysis, necrotic nodal metastasis (odds ratio [OR] = 7.310, p = 0.011) was an independent predictor of regional failure, while advanced nodal stage (OR = 4.119, p = 0.022) and cystic nodal metastases (OR = 0.087, p = 0.026) were independent positive and negative predictors of distant failure, respectively.ConclusionsCervical cystic and necrotic nodal metastases are associated with HPV-induced p16-positive and p16-negative OPSCC, respectively. Patients with necrotic nodal metastasis at presentation have an increased risk of regional failure. Distant failure is directly and inversely correlated with advanced nodal stage and cystic nodal metastasis, respectively.

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