Retropharyngeal Lymph Node Involvement in Oropharyngeal Carcinoma: Impact upon Risk of Distant Metastases and Survival Outcomes.

Zsuzsanna Iyizoba-Ebozue,Sriram Vaidyanathan,Karen E Dyker,Andrew F Scarsbrook,Louise J Murray,Robin J D Prestwich,Moses Arunsingh

doi:10.3390/cancers12010083

Zsuzsanna Iyizoba-Ebozue, Sriram Vaidyanathan + Show 5 more

Open Access

https://doi.org/10.3390/cancers12010083

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Journal: Cancers	Publication Date: Dec 29, 2019
Citations: 8	License type: CC BY 4.0

Affiliation: St James's University Hospital, University of Leeds

Abstract

The influence of retropharyngeal lymph node (RPLN) involvement on prognosis in oropharyngeal carcinoma remains poorly defined. The aim of this study was to assess the impact of RPLN involvement upon outcomes. A single-centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated nonsurgically between 2010 and 2017 was performed. All had a baseline 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG) PET-CT and contrast-enhanced MRI and/or CT. RPLN status was determined by radiology review of cases with reported abnormal RPLN. Multivariate backwards logistic regression was used to examine impact on outcomes of factors. Abnormal RPLNs were identified in 40/402 (10%) of patients. Median follow up was 42.9 months. RPLN involvement was associated with inferior 3 year outcomes for overall survival (OS) (67.1% vs. 79.1%, p = 0.006) and distant metastases-free survival (DMFS) (73.9% versus 88.0%, p = 0.011), with no significant difference in local control (81.6% vs. 87.7%, p = 0.154) or regional control (80.7% vs. 85.4%, p = 0.252). On multivariate analysis abnormal RPLN, no concurrent chemotherapy and ongoing smoking were associated with inferior DMFS and OS, while advanced T stage was also associated with inferior OS. In summary, RPLN involvement, present in 10% of patients, was an independent prognostic factor for the development of distant disease failure translating into inferior OS. These findings need confirmation in future studies.

Highlights

Nonsurgical treatment with radiotherapy and chemotherapy is a standard of care for the management of oropharyngeal carcinoma [1]
We have recently reported on the incidence and patterns of retropharyngeal lymph node (RPLN) involvement in oropharyngeal carcinoma in a series of 402 patients treated with chemoradiotherapy who had baseline
Received induction chemotherapy followed by concurrent chemotherapy and 308/402 (76.6%) received concurrent chemotherapy without induction

Summary

Introduction

Nonsurgical treatment with radiotherapy and chemotherapy is a standard of care for the management of oropharyngeal carcinoma [1]. Human papilloma virus (HPV)-related oropharyngeal carcinoma has a more favourable prognosis than non-HPV-related disease [1,2]. There has been considerable interest in exploring “de-escalation” strategies for better disease prognosis in view of the substantial toxicity of chemoradiotherapy [3,4,5,6]. The negative results of recent de-escalation studies seeking to replace concurrent cisplatin with cetuximab [3,6] emphasise the importance of accurate identification of patients with low-risk disease. Cancers 2020, 12, 83 concern, even in apparently favourable prognosis disease [7]. Rates of distant metastases appear similar for HPV-positive and -negative disease, with controversy over whether HPV status influences the pattern of distant metastases [7,8,9,10]

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