Long-term regional control in the observed neck following definitive chemoradiation for node-positive oropharyngeal squamous cell cancer.

Abstract

Traditionally, patients treated with chemoradiotherapy for node-positive oropharyngeal squamous cell carcinoma (N+ OPSCC) have undergone a planned neck dissection (ND) after treatment. Recently, negative post-treatment positron-emission tomography (PET)/computed tomography (CT) imaging has been found to have a high negative predictive value for the presence of residual disease in the neck. Here, we present the first comprehensive analysis of a large, uniform cohort of N+ OPSCC patients achieving a PET/CT-based complete response (CR) after chemoradiotherapy, and undergoing observation, rather than ND. From 2002 to 2009, 302 patients with N+ OPSCC treated with 70 Gy intensity-modulated radiation therapy and concurrent chemotherapy underwent post-treatment clinical assessment including PET/CT. CR was defined as no evidence of disease on clinical examination and post-treatment PET/CT. ND was reserved for patients with <CR on either PET/CT, clinical examination, or other imaging. 260 patients (86.1%) had clinical and radiographic CRs, and underwent neck observation (rate of regional control, 97.7%; 5-year overall survival, 79.8%). The four observed patients experiencing neck recurrence had initial staging of N1 (n = 2), N2b (n = 1), and N2c (n = 1). Three of four were successfully surgically salvaged. There was no association between N stage and rate of neck recurrence (p = 0.74). 52 and 25% of patients undergoing ND had viable tumor in the neck after positive and negative PET/CT, respectively. We conclude that patients achieving CRs after chemoradiation, based on clinical and PET/CT assessment, have a high probability of regional control, with a 2.3% regional failure rate, and may be safely observed without planned ND.

• Authors: Anuj Goenka, Luc G T Morris, Shyam S Rao, Suzanne L Wolden, Richard J Wong, Dennis H Kraus, Nisha Ohri, Jeremy Setton, Benjamin H Lok, Nadeem Riaz, Borys R Mychalczak, Heiko Schoder, Ian Ganly, Jatin P Shah, David G Pfister, Michael J Zelefsky, Nancy Y Lee
• Journal: International journal of cancer (Int J Cancer) Vol. 133 Issue 5 Pg. 1214-21 (Sep 01 2013) ISSN: 1097-0215 [Electronic] United States
• PMID: 23436584 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 UICC.

Topics

• Adult
• Aged
• Carcinoma, Squamous Cell (diagnostic imaging, pathology, therapy)
• Chemoradiotherapy
• Female
• Humans
• Lymphatic Metastasis
• Male
• Middle Aged
• Multimodal Imaging
• Neck
• Oropharyngeal Neoplasms (diagnostic imaging, pathology, therapy)
• Papillomaviridae (isolation & purification)
• Positron-Emission Tomography
• Tomography, X-Ray Computed