Abstract
We aimed to define clinicopathologic risk factors associated with regional recurrence (RR) and thus the effectiveness of postoperative radiotherapy (PORT) for neck control for head and neck squamous cell carcinomas (HNSCCs) with differing cervical lymph node status. A retrospective study was performed in 196 HNSCC patients with pathologically positive neck node (N+) to evaluate the high-risk factors for RR and to define the role of PORT in control after neck dissection and postoperative radiotherapy (PORT). Overall, the RR rate after neck dissection and PORT was 29%. Extracapsular spread (ECS) was confirmed to be the only independent risk factor for RR. There were no significant risk factors associated with RR in the ECS- group. The 5-year disease-specific survival rate was 45%, which descended to 10% with the emergence of RR. ECS remains a determined risk factor for RR after neck dissection and PORT in patients with N+. PORT alone is not adequate for preventing RR in the neck with ECS after neck dissection. More intensive postoperative adjuvant therapies, especially combined chemotherapy and radiotherapy, are needed to prevent regional failure in HNSCC patients with ECS.
Highlights
It is well known that head and neck squamous cell carcinomas (HNSCCs) is a loco-regional disease and its treatment regimen should include management of both primary tumor and cervical metastatic disease
We aimed to define clinicopathologic risk factors associated with regional recurrence (RR) and the effectiveness of postoperative radiotherapy (PORT) for neck control for head and neck squamous cell carcinomas (HNSCCs) with differing cervical lymph node status
A retrospective study was performed in 196 HNSCC patients with pathologically positive neck node (N+) to evaluate the high-risk factors for RR and to define the role of PORT in control after neck dissection and postoperative radiotherapy (PORT)
Summary
It is well known that HNSCC is a loco-regional disease and its treatment regimen should include management of both primary tumor and cervical metastatic disease. Even with significant advances in surgery and radiotherapy for HNSCC treatment in the past several decades, there are still many patients failed in the neck, especially in advanced cases. Adequate neck management has a major impact on the survival of patients with HNSCC. The incidence of recurrent diseases following neck dissection with adjuvant radiotherapy for neck metastases is reasonably low, which maintains 10%20% (Jones et al, 2008), the deteriorated survival after RR makes us to seek more effective therapeutic modalities for neck control. With the advent of new techniques in chemotherapy and biological therapy, clinical oncologists are making efforts to explore individualized combinedtherapeutic regimens for HNSCC patients to prevent recurrence by targeting the identified high risk factors.
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