HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation: The risk of subclinical disease in ipsilateral levels IB, IV and V

Abstract

Background To assess the risk of subclinical neck nodal involvement of levels IB, IV and V for early T-stage, node positive, human papilloma virus (HPV)-related oropharyngeal carcinoma. Material and methods We retrospectively identified the patients with clinically positive and un-violated neck that underwent upfront ipsilateral neck dissection for HPV-related oropharyngeal cancer between 1998 and 2010. From the pathology report we extracted the prevalence rate of involvement of each selected level and then estimated the risk that a level that does not contain any node larger than 10 mm at computed tomography (CT) harbors subclinical disease. Predictors of involvement were investigated as well. Results Ninety-one patients were analyzed. The risk of subclinical disease in both levels IB and V is < 5%, while it is 6.5% (95% CI 3.1–9.9%) for level IV. Level IB subclinical involvement slightly exceeds 5% when 2 + ipsilateral levels besides IB are involved. The risk of occult disease in level IV tends to be < 5% when level III is not involved. Conclusion These data support the exclusion from the elective nodal volume of level V and level IB but when 2 + other levels are involved. Level IV might also be spared when level III is negative. Clinical implementation within a prospective study is justified.

Feasibility and relevance of level I substation node counts in oropharyngeal carcinoma

“…Sanguineti et al 17,18 have attempted to analyze the risk of nodal disease in levels IB, IV, and V. The subclinical nodal positivity rates are similar to what we found in our institution. They have suggested that these data can be used to reduce volumes and doses of radiotherapy.…”

Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review

“…Studies are from the early 1990s; the patients could have been treated prior to this and the management of head and neck cancer has evolved since that time. The studies by Sanguineti et al and Pattani et al may overlap in terms of the patients studied, which may distort the results of this review …”

Bone metastases from head & neck squamous cell carcinoma (HNSCC) – Reviewing the patients’ background and imaging features mainly of whole body MRI (WBMRI)

“…The numbers of these cases are too few. However, NPC is closely related to Epstein-Barr virus (EBV), peculiar natural history and a good prognosis [11] and OPC is also closely related with Human papilloma virus (HPV) 16 [12]. Indeed, in our two cases of NPC, EBV and also in our three cases of OPC, HPV 16 were proven.…”