Prognostic importance of radiologic extranodal extension in HPV-positive oropharyngeal carcinoma and its potential role in refining TNM-8 cN-classification

Huang, Shao Hui; O’Sullivan, Brian; Su, Jie; Bartlett, Eric; Kim, John; Waldron, John; Ringash, Jolie; Almeida, John R. de; Bratman, Scott V.; Hansen, Aaron Richard; Bayley, Andrew; Cho, John; Giuliani, Meredith; Hope, Andrew; Hosni, Ali; Spreafico, Anna; Siu, Lillian L.; Chepeha, Douglas B.; Li, Tong; Xu, Wei; Yu, Eugene

doi:10.1016/j.radonc.2019.10.011

Cited by 37 publications

(53 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17,18 Treatment and Outcome Assessment All patients were managed with multidisciplinary input according to institutional protocols as previously described. 19 Treatment decisions were based on patient wishes and multidisciplinary team discussions including at least a radiation oncologist, a medical oncologist, and…”

Section: Study Populationmentioning

confidence: 99%

Hypofractionated radiotherapy alone with 2.4 Gy per fraction for head and neck cancer during the COVID‐19 pandemic: The Princess Margaret experience and proposal

Huang

O’Sullivan

et al. 2020

Cancer

Self Cite

View full text Add to dashboard Cite

BACKGROUND: The objective of this study was to identify a subgroup of patients with head and neck squamous cell carcinoma (HNSCC) who might be suitable for hypofractionated radiotherapy (RT-hypo) during the COVID-19 pandemic. METHODS: HNSCC cases (oropharynx/larynx/hypopharynx) treated with definitive RT-hypo (60 Gy in 25 fractions over 5 weeks), moderately accelerated radiotherapy (RT-acc) alone (70 Gy in 35 fractions over 6 weeks), or concurrent chemoradiotherapy (CCRT) during 2005-2017 were included. Locoregional control (LRC) and distant control (DC) after RT-hypo, RT-acc, and CCRT were compared for various subgroups. RESULTS: The study identified 994 human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma cases (with 61, 254, and 679 receiving RT-hypo, RT-acc, and CCRT, respectively) and 1045 HPV-HNSCC cases (with 263, 451, and 331 receiving RT-hypo, RT-acc, and CCRT, respectively). The CCRT cohort had higher T/N categories, whereas the radiotherapy-alone patients were older. The median follow-up was 4.6 years. RT-hypo, RT-acc, and CCRT produced comparable 3-year LRC and DC for HPV+ T1-2N0-N2a disease (seventh edition of the TNM system [TNM-7];

show abstract

Section: Study Populationmentioning

confidence: 99%

Hypofractionated radiotherapy alone with 2.4 Gy per fraction for head and neck cancer during the COVID‐19 pandemic: The Princess Margaret experience and proposal

Huang

O’Sullivan

et al. 2020

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…): maximum axial LN diameter and the presence/absence of LN-cal, 7 necrosis, cystic appearance, 15,16 rENE, or coalescent nodal mass. 6,14 The cystic component had a homogeneous near-water attenuation (< 25 Hounsfield unit [HU]) 16 with well-defined smooth margins, and might occupy almost the entire LN 15 or manifest cystic foci within a LN. 16 A necrotic node contained areas of heterogeneous low attenuation (10-25 HU) with thicker irregular enhancing rim.…”

Section: Assessment Of Pre-rt and Post-rt Radiological Nodal Featuresmentioning

confidence: 99%

“…17 rENE was classified under a general rubric containing either a single involved LN manifesting an unequivocal ill-defined nodal border (i.e., a clearly discernible loss of the sharp plane between an LN capsule and the surrounding fat), or a coalescent nodal mass defined as two or more LNs abutting one another with loss of the intervening fat plane due to replacement by extranodular extension (ENE). 6 Example of these various features are shown in Figure 1 and Supporting Information Appendix S1 Supplement 1. Post-RT nodal features were only applicable for those with residual LN, defined as a LN >1.0 cm in axial diameter identified on post-RT CT based on modified response evaluation in solid tumor.…”

Section: Assessment Of Pre-rt and Post-rt Radiological Nodal Featuresmentioning

confidence: 99%

“…All patients were managed in a multidisciplinary setting according to institutional practice guidelines as described previously. 6,14 Generally, stage I to II disease was treated with RT-alone; stage III or early-stage IV disease was treated with either altered fractionated RT alone or concurrent chemoradiation (CRT); and in advanced stage IV disease, CRT was standard for all patients fit for chemotherapy. RT was delivered using intensitymodulated RT techniques with daily image guidance.…”

Section: Treatmentmentioning

confidence: 99%

“…Radiologic extranodal extension (rENE), including the development of a coalescent nodal mass (partially addressed by the term matted nodes 4,5 ) is one of the most important prognostic nodal features. 6 LN calcification (LN-cal) is also associated with worse outcomes in several cancers, including head and neck cancers (HNC). [7][8][9] However, its frequency and prognostic value in HPV-positive and HPV-negative OPC remains unknown.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pre‐ and Post‐Radiotherapy Radiologic Nodal Features and Oropharyngeal Cancer Outcomes

Sananmuang

et al. 2020

The Laryngoscope

Self Cite

View full text Add to dashboard Cite

Objectives: To assess the prognostic value of pre-/post-radiotherapy (pre-/post-RT) radiologic lymph node (LN) features in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal carcinoma (OPC) patients treated with definitive (chemo-)RT. Methods: Clinical node-positive OPCs treated from 2011 to 2015 were reviewed. Nodal features were reviewed by a radiologist on pre-/post-RT computed tomography (CTs). Univariable analysis calculated hazard ratio (HR) for regional failure (RF), distant metastasis (DM), and deaths. Multivariable analysis estimated adjusted HR (aHR) of significant nodal features identified in univariable analysis adjusting for confounders. Results: Pre-RT CT was undertaken in 344 HPV-positive and 94 HPV-negative OPC patients, of whom 242 (70%) HPV-positive and 67 (71%) HPV-negative also had a post-RT CT. Median follow-up was 4.9 years. Pre-RT LN calcification (pre-RT_LN-cal) increased the risk of RF in HPV-negative (aHR: 5.3, P = .007) but not HPV-positive patients (P = .110). Pre-RT radiologic extranodal extension (pre-RT_rENE+) increased the risk of DM and death in both HPV-negative (DM: aHR 6.6, P < .001; death: aHR 2.1, both P = .019) and HPV-positive patients (DM: aHR 4.9; death: aHR 3.0, both P < .001). Increased risk of RF occured with < 20% post-RT LN size reduction in both HPV-negative (HR 6.0, P = .002) and HPV-positive cases (HR 3.0, P = .049). Post-RT_LN-cal did not affect RF, DM, or death regardless of tumor HPV status (all P > .05). Conclusion: Pre-RT_LN-cal is associated with higher RF risk in HPV-negative but not in HPV-positive patients. Pre-RT_rENE increases risk of DM and death regardless of tumor HPV status. Minimal post-RT LN size reduction (< 20%) increases risk of RF in both diseases. Post-RT_LN-cal + has no apparent influence on outcomes in either disease.

show abstract

Nodal staging convergence for HPV− and HPV+ oropharyngeal carcinoma

Luu

Kim

et al. 2021

Cancer

View full text Add to dashboard Cite

BACKGROUND: Modern disease staging systems have restructured human papillomavirus (HPV)-negative (HPV−) and HPV-positive (HPV+) oropharyngeal carcinoma (OPC) into distinct pathologic nodal systems. Given that quantitative lymph node (LN) burden is the dominant prognostic factor in most head and neck cancers, we investigated whether HPV− and HPV+ OPC warrant divergent pathologic nodal classification. METHODS: Multivariable Cox regression models of OPC surgical patients identified via U.S. cancer registry data were constructed to determine associations between survival and nodal characteristics. Nonlinear associations between metastatic LN number and survival were modeled with restricted cubic splines. Recursive partitioning analysis (RPA) was used to derive unbiased nodal schema. RESULTS: Mortality risk escalated continuously with each successive positive LN in both OPC subtypes, with analogous slope.

show abstract

Prognostic importance of radiologic extranodal extension in HPV-positive oropharyngeal carcinoma and its potential role in refining TNM-8 cN-classification

Cited by 37 publications

References 35 publications

Hypofractionated radiotherapy alone with 2.4 Gy per fraction for head and neck cancer during the COVID‐19 pandemic: The Princess Margaret experience and proposal

Hypofractionated radiotherapy alone with 2.4 Gy per fraction for head and neck cancer during the COVID‐19 pandemic: The Princess Margaret experience and proposal

Pre‐ and Post‐Radiotherapy Radiologic Nodal Features and Oropharyngeal Cancer Outcomes

Nodal staging convergence for HPV− and HPV+ oropharyngeal carcinoma

Contact Info

Product

Resources

About