Outcomes of head and neck squamous cell carcinoma patients with N3 neck disease treated primarily with chemoradiation versus surgical resection

Abstract

Patients with head and neck squamous cell cancer and N3 neck disease have at least equivalent survival with primary surgical treatment versus primary CRT. Primary surgical resection with appropriate adjuvant therapy should be considered for patients with resectable N3 disease, especially patients with nonoropharyngeal sites. Post-CRT neck dissections did not change the OS of patients with N3 disease.

Clinical outcomes for patients presenting with N3 head and neck squamous cell carcinoma: Analysis of the National Cancer Database

“…We previously reported our institutional experience regarding clinical outcomes of N3 HNSCC (under review). Similar to other series, we demonstrated 5‐year rates of locoregional and distant control of approximately 75% and 60%, respectively . Further, we demonstrated an improvement in locoregional control with surgery and a trend toward improved survival in patients with p16‐positive oropharyngeal primary tumors.…”

“…The NCDB does not record whether or not the N3 lymph node is resectable. For patients with N3 HNSCC, the prevalence of unresectable nodal disease has been reported to be approximately 20%‐30% and impacts both disease‐free and overall survival outcomes . Therefore, a sensitivity analysis utilizing assumed prevalence and HRs was performed to assess the impact of the unmeasured nodal confounder on overall survival.…”

“…Given the lack of N3‐specific data, patients are commonly treated according to recommendations for those with N2 nodal disease. However, data suggests that N3 nodal disease is associated with a worse outcome . Therefore, a better understanding of the prognostic implications of N3 nodal disease and clinical outcomes of differing management approaches in the context of the primary tumor site will enable more appropriate management of this uncommon disease presentation.…”

Outcomes of surgically treated human papillomavirus–related oropharyngeal squamous cell carcinoma with N3 disease

“…The few studies that specifically evaluate outcomes of a primary surgical paradigm for N3 OPSCC show similarly high survival rates but are limited by sample size. Sakashita et al reported a 100% 4‐year OS for six patients, and Smyth et al found a 5‐year overall survival of 80% in 10 patients.…”

“…Ultimately, however, survival outcomes specific to HPV‐related N3 disease are unclear given the relative lack of available data. Many reports of treatment outcomes for N3 neck disease either group multiple head and neck subsites or do not include HPV status if reporting on oropharyngeal primaries . Those that include specifically HPV‐related disease often group N2 and N3 stages for analysis or have a very limited sample size of N3 patients …”