Neck control after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancers

Abstract

Background: The purpose of this study was to evaluate neck control outcomes after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancer. Methods: We retrospectively reviewed medical records of fifty patients with node-positive head and neck cancer who received definitive radiochemotherapy. Twelve patients subsequently underwent neck dissection for suspicious recurrent or persistent disease. A median dose of 70 Gy (range 60-70.6) was delivered to involved nodes. Response evaluation was performed at a median of 5 weeks after completion of radiotherapy. Results: Neck failure was observed in 11 patients and the 3-year regional control (RC) rate was 77.1%. Neck dissection was performed in 10 of the 11 patients; seven of these cases were successfully salvaged, and the ultimate rate of neck control was 92%. The remaining two patients who received neck dissection had negative pathologic results. On univariate analysis, initial nodal size > 2 cm, a less-than-complete response at the primary site, post-radiotherapy nodal size > 1.5 cm, and post-radiotherapy nodal necrosis were associated with RC. On multivariate analysis, less-than-complete primary site response and post-radiotherapy nodal necrosis were identified as independent prognostic factors for RC. Conclusions: The neck failure rate after definitive radiochemotherapy without planned neck dissection was 22%. Two-thirds of these were successfully salvaged with neck dissection and the ultimate neck control rate was 92%. Our results suggest that planned neck dissection might not be necessary in patients with complete response of primary site, no evidence of residual lesion > 1.5 cm, or no necrotic lymph nodes at the 1-2 months follow-up evaluation after radiotherapy.

No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression

“…29 % of our patients with PND 6-8 weeks after the end of primary IMRT demonstrated histologically a nodal tumor persistence, which is in line with a recent investigation by Goenka et al [19] and Jang et al [35]. In our SND cohort the rate of regional persistence based on radiological assessment 3 months posttreatment was with 18 % slightly lower.…”

Radiation therapy for nasopharyngeal carcinoma: the predictive value of interim survival assessment

“…Our findings are similar to those of Jang et al . [ 15 ], who reviewed 50 patients with node-positive head and neck cancer, including 25 patients with NPC who underwent RT, and found that a post-RT nodal size >15 mm was associated with poor RC. Our study further suggests that the LN size at interim assessment predicts not only RC but also survival.…”

“…Non-CR was recorded when CR criteria were not fulfilled. Only the treatment responses of primary lesions were assessed based on RECIST criteria [ 15 ]. Because no precise criteria for CR of the LNs are available, we measured the short axis of the largest LN.…”

Case Serie of Hybrid Brachytherapy followed by Intensity Modulated Radiation Therapy (HyBIRT) Technique for the Definitive Management of Tongue Squamous Cell Carcinoma (TSCC)

“…Published tongue brachytherapy series used uniform sequence of EBRT followed by either low-dose-rate (LDR) or high-dose-rate interstitial brachytherapy (HDRIBT) to the residual TSCC, with a signi cant number of patients being subjected to salvage neck dissection after the EBRT for persistent disease in the neck [15] - [18]. Recent series in the de nitive EBRT setting showed 3-to 10-year regional nodal control rates in the range of 77.1 -78% for head and neck squamous cell carcinomas (HNSCC) without planned neck dissection [9], [19]. IBT on the other hand gives a good LC rate of 80 -100% at 2 years for T1-T3 disease, and 94% at 5 years to the primary site in TSCC [5], [6].…”