Outcomes of Primary Surgery with Radiotherapy for pN2 Head and Neck Squamous Cell Carcinoma

Abstract

Objectives: Examine treatment outcomes and define factors that influence survival in patients underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma. Methods: Two hundred nine patients underwent primary surgery with postoperative radiotherapy between 1994 and 2011. Primary tumor sites were 70 oropharynx, 48 hypopharynx, 47 larynx, 41 oral cavity, and 3 sinonasal cavity. There were 21, 83, 60 and 45 patients with stage T1 to T4 cancers, respectively. The N stages were 20 N2a, 129 N2b, and 60 N2c. Results: The recurrence rate was 40% (83/209) over a mean observation period of 39 months. The 5-year disease free survival (DFS), disease specific survival (DSS), and overall survival (OS) rate in our cohort was 44%, 60%, and 56%, respectively. Patients with advanced T stage or extracapsular spread had a significant adverse effect on 5-year DFS, DSS, OS rate according to the Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between 5-year DSS rate and advanced T stage (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.26-3.82; P = 0.005) and extracapsular spread (HR, 2.29; 95% CI, 1.24-4.21; P = 0.008). Conclusions: Factors that affected prognosis were T stage and extracapsular spread in patients who underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma. An aggressive therapeutic approach may be suitable for these patients.