Enfermedad ganglionar residual tras quimiorradioterapia con intención radical en pacientes con tumores de faringolaringe

Abstract

Introduction and objective: Cervical nodal involvement is the main prognostic factor in squamous cell carcinoma of the head and neck. Salvage surgery is considered the most curative intervention for residual or recurrent disease after treatment with chemo-radiotherapy. The objectives of the study were to describe the epidemiological data of the patients, to evaluate the usefulness of the imaging tests, to analyze the survival, and to make a review of the current bibliography. Method: A retrospective study was carried out, including patients undergoing cervical lymph node surgery between January 2010 and December 2015, after radiological suspicion of persistent regional disease was found. All the patients had previously received chemo-radiotherapy treatment with radical intention due to a carcinoma of pharynx or larynx. Results: Thirty patients were included. The most common tumoral site was supraglottis (13). The most frequent histological result was poorly and moderately differentiated epidermoid carcinoma (10 cases in each). Sixty percent of the patients had stage IVa. The positive predictive value (PPV) of the CT scan was 55.26%. Eighty-seven point five percent of the histologies confirming radiological diagnostic suspicion in a first surgery occurred in patients who had an early CT scan. Overall survival was 53.33%; forty percent of the patients were free of disease at the end of the period. Conclusions: The low PPV of the CT scan makes its usefulness questionable as a method to assess nodal response to chemo-radiotherapy. It seems reasonable to propose selective lymph node surgery in selected patients.