Upstaging of head and neck cancers due to extranodal extension: An Indian study.

Abstract

e17553 Background: Latest AJCC staging has included extranodal extension (ENE) in nodal staging of head and neck cancers (HNC) in view of its prognostic significance. Presence of clinical ENE makes the disease N3b and the stage grouping will be stage IVB. This retrospective analysis was done with an objective to find out the percentage of patients with HNC getting upstaged because of ENE and their treatment outcome. Methods: A retrospective analysis of all HNC patients registered in our department from January 2018 to January 2019 were done to identify the presence of ENE and their staging. AJCC criteria was used for defining clinical and radiological ENE. The site, subsite, stage and presence of ENE were documented. Results: A total of 562 patients were registered with HNC. Among them 40 patients were identified to have ENE (7.1%). There were 35 males and 5 females. There were 17 cases with ca oropharynx, 13 oral cavity, four hypopharynx, three supraglottis, two glottis, and one maxillary carcinoma. Tumour size varied from 1.5 cm to 8 cm with an average of 4.9cm. Majority of the patient had a T4a disease, with 18 patients in the category. T stage varied from T1 – 1, T2 – 7, T3 – 7, T4b – 6, missing data – 1. 33 patients had clinically documented ENE and six were radiological and one patient had pathological ENE. Nine had skin involvement and the rest (24) had either muscle invasion or soft tissue involvement. Various treatment approaches were tried. Two patients received neoadjuvant chemotherapy (NACT) followed by chemoradiation (CTRT). On treatment at present. One NACT followed by surgery and later CTRT. Developed recurrence. Four patients received palliative chemotherapy, but developed progressive disease (PD), on best supportive care (BSC). Nine patients received palliative radiotherapy, six patients are on treatment and one had PD. Five patients received radical CTRT, 5 on treatment and one had PD. One received palliative RT followed by palliative chemo, but developed PD. 13 patients are on treatment and rest of the patients are either dead, lost to follow up or on BSC. Conclusions: Majority of the patients with ENE had a T4a disease. No special site predilection was identified. Various treatment modalities tried but none of them produced any significant difference in outcome. In conclusion, patients with ENE had a poor prognosis irrespective of the treatment modality selected.