Patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma after first-line treatment with surgery and/or intensity-modulated radiotherapy

Dongqing Wang,Shui Yu,Jin Xu,Limin Zhai,Baosheng Li

doi:10.1186/s12885-020-06793-6

Abstract

BackgroundTo identify the spatial patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma (SCC) after first-line treatment with surgery and/or intensity-modulated radiotherapy (IMRT).MethodsWe retrospectively obtained the clinicopathological characters of 123 hypopharyngeal SCC patients, and investigated the patterns of regional lymph node failure. Univariate and multivariate logistic regression were used to determine the risk factors of regional lymph node failure.ResultsForty patients (32.5% of total patients) were suffered regional lymph node failure. In these patients, the ipsilateral neck level II nodal failure account for 55.0% (22/40) followed by level III 30.0% (12/40), level VIb 15.0% (6/40), level VII 15.0% (6/40), and level IV 5.0% (2/40). In addition, 17.5% (7/40) patients suffered contralateral neck level II nodal failure and 7.5% (3/40) patients suffered level III nodal failure. The common failure levels were the II (7/46, 15.2%), III (4/46, 8.7%), VIb (4/46, 8.7%), and VII (5/46, 10.9%) for treatment by surgery. The lymph node recurrence and persistent disease at levels II (19/77, 24.7%) and III (10/77, 13.0%) remained the major cause of failure following curative intent of IMRT. The postoperative radiation significantly decreased the risk of regional lymph node failure (OR = 0.082, 95% CI: 0.007–1.000, P = 0.049); and the radiologic extranodal extension significantly increased the risk of regional lymph node failure (OR = 11.07, 95% CI: 2.870–42.69, P < 0.001).ConclusionsWhatever the treatment modality, the lymph node failure at level II and III was the most popular pattern for hypopharyngeal SCC. Moreover, for patients who underwent surgery, the nodal failure at level VIb and VII was frequent. Thus, postoperative radiation of level VIb and VII may give rise to benefit to locally advanced hypopharyngeal SCC patients.

Highlights

To identify the spatial patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma (SCC) after first-line treatment with surgery and/or intensity-modulated radiotherapy (IMRT)
The poor prognosis of hypopharyngeal SCC may result from the facts that early stage of hypopharyngeal SCC often fails to cause any signs or symptoms, and this delays the diagnosis of hypopharyngeal carcinoma [1,2,3]
We reported the follow-up results of frequency and distribution of lymph node failure at each nodal level for 123 patients with locally advanced hypopharyngeal SCC undergoing first-line treatment with surgery and/or IMRT

Summary

Introduction

To identify the spatial patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma (SCC) after first-line treatment with surgery and/or intensity-modulated radiotherapy (IMRT). Squamous cell carcinoma (SCC) of the hypopharynx is relatively rare and accounts for 3 to 7% of all head and neck cancers [1,2,3]. As for advanced unresectable tumors, such as stage IVb diseases, and for patients requiring organ preservation, concurrent radiotherapy (RT) and high-dose cisplatin is recommended treatment schedule in national comprehensive cancer network (NCCN) guideline for cancer of hypopharynx [7]. Biau et al [8] updated the international consensus guidelines for the delineation of the neck node levels of head and neck cancers. There is still no consensus on the extent to which prophylactic treatment regional nodal basin needs to be included in adjuvant

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