PET-CT staging of the neck in cancers of the oropharynx: patterns of regional and retropharyngeal nodal metastasis

Marcie Tauzin,Rohan R Walvekar,Joseph L Hagan,Amy Rabalais,Charles G Wood,Robert L Ferris

doi:10.1186/1477-7819-8-70

Abstract

ObjectiveTo study the retropharyngeal lymph node status (RPLN) by pretreatment PET-CT imaging in patients with squamous cell carcinomas of the oropharynx (OPSCC). Study Design: Retrospective.Methods101 patients with a biopsy proven OPSCC were identified. 53 patients meeting inclusion criteria were further analyzed.ResultsThe frequency of RPLN was 20.8% (11/53). Advanced T stage cancer (OR = 5.6250, 95% CI: 1.06 - 29.80, p = 0.0410) and advanced clinical N stage cancer (i.e. N2+) had higher odds (OR = 3.9773, 95% CI: 0.9628 - 16.4291) of being RPLN positive as compared to N0-1 patients.ConclusionsPre-treatment PET-CT can be used as a staging tool to aid in treatment planning of OPSCC, as rates of RPLN and nodal metastasis are consistent with those reported in the literature. Advanced T and N stage are associated with a greater odds ratio of being RPLN positive by PET-CT imaging.

Highlights

Over the last two decades there has been a gradual shift in the presentation of oropharyngeal squamous cell carcinoma (OPSCC), with an increased incidence in a younger patient population[1,2]
A hundred and one patients treated at Mary Bird Perkins Cancer Center (MBPCC) between September 2002 and March 2008, with biopsy proven squamous cell carcinoma of the oropharynx were identified by searching the MBPCC patient data base with appropriate ICD-9 codes
Treatment details All patients were treated with intensity-modulated radiation therapy (IMRT) at MBPCC with an average dose to

Summary

Introduction

Over the last two decades there has been a gradual shift in the presentation of OPSCC, with an increased incidence in a younger patient population[1,2]. Radiotherapy or chemoradiotherapy has been advocated as the treatment of choice for oropharyngeal squamous cell carcinoma (OPSCC) to avoid morbidity of traditional surgical resection [3,4]. RPLN dissection involves resection of this nodal basin up to the skull base along with the primary site in an en bloc fashion, using a mandibularsplitting procedure in most cases [7-9] This approach divides the small nerves of the pharyngeal plexus in the process of separating the pharyngeal wall from the structures of the carotid sheath and can be associated with increased severity of dysphagia [10]. Neck dissections do not routinely address RPLNs; creating a potential for recurrence in the retropharynx and the need to address this nodal basin with radiotherapy This has been one of the criticisms of primary surgical treatment for OPSCC

Methods

Results

Conclusion