N3 Neck Disease Research Articles

158 PET CT response outcomes in curatively treated oropharyngeal SCC with bulky N3 neck disease

158 PET CT response outcomes in curatively treated oropharyngeal SCC with bulky N3 neck disease

Risk stratification and corresponding postoperative treatment strategies for occult contralateral lymph node metastasis in pyriform sinus squamous cell carcinoma patients with ipsilateral node-positive necks.

BackgroundTo quantitatively predict the probability of occult contralateral lymph node metastasis (cLNM) for pyriform sinus squamous cell carcinoma (PSSC) patients with ipsilateral node-positive necks to guide postoperative adjuvant treatment.MethodsTwo hundred and twenty-seven PSSC patients with ipsilateral lymph node metastasis (iLNM) were retrospectively analyzed.ResultsMultivariate logistic analyses showed that five factors including maximum tumor diameter (MTD) of more than 4.0 cm, existence of tumor extension across the midline (EAM), internal jugular vein adhesion (IJVA), lymphovascular invasion (LVI), and lymph nodal fusion (LNF) were independent risk factors for cLNM. A predictive nomogram was created based on these factors. The accuracy and validity of our model were verified by concordance index (C-index) 0.862 [95% confidence interval (CI): 0.810–0.914] in development cohort and 0.860 (95% CI: 0.820–0.900) after 1,000 bootstrapping. The calibration curve also showed a relatively favorable agreement. We then stratified patients into three groups based on their cLNM risk scores. Possible cLNM rates for low-risk, moderate-risk, and relatively high-risk subgroups were 3.6%, 21.8%, and 60.7%, respectively.ConclusionsA new postoperative adjuvant radiotherapy (PART) strategy selection flow chart was created for PSSC patients based on our newly built nomogram which can effectively predict the individualized possibility of cLNM. For patients in high-risk subgroup, therapeutic-dose PART is highly recommended even for those with contralateral clinical N0 neck disease. For those in moderate-risk subgroup, prophylactic-dose PART is recommended. However, for patients in low-risk subgroup, regular follow-up is sufficient given the extremely low occult cLNM rate.

Laryngeal cancer: United Kingdom National Multidisciplinary guidelines.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Significantly new data have been published on laryngeal cancer management since the last edition of the guidelines. This paper discusses the evidence base pertaining to the management of laryngeal cancer and provides updated recommendations on management for this group of patients receiving cancer care. Recommendations • Radiotherapy (RT) and transoral laser microsurgery (TLM) are accepted treatment options for T1a-T2a glottic carcinoma. (R) • Open partial surgery may have a role in the management of selected tumours. (R) • Radiotherapy, TLM and transoral robotic surgery are reasonable treatment options for T1-T2 supraglottic carcinoma. (R) • Supraglottic laryngectomy may have a role in the management of selected tumours. (R) • Most patients with T2b-T3 glottic cancers are suitable for non-surgical larynx preservation therapies. (R) • Concurrent chemoradiotherapy should be regarded as the standard of care for non-surgical management. (R) • Subject to the availability of appropriate surgical expertise and multi-disciplinary rehabilitation services, TLM or open partial surgical procedures ± post-operative RT, may be also be appropriate in selected cases. (R) • In the absence of clinical or radiological evidence of nodal disease, elective treatment (RT or surgery ± post-operative RT) is recommended to at least lymph node levels II, III and IV bilaterally. In node positive disease, it is recommended that lymph node levels II-V should be treated on the involved side. If level II nodes are involved, then elective irradiation of ipsilateral level Ib nodes may be considered. (R) • Most patients with T3 supraglottic cancers are suitable for non-surgical larynx preservation therapies. (R) • Concurrent chemoradiotherapy should be regarded as the standard of care for non-surgical management. (R) • Subject to the availability of appropriate surgical expertise and multi-disciplinary rehabilitation services, TLM or open partial surgical procedures ± post-operative RT, may also be appropriate in selected cases. (R) • In the absence of clinical or radiological evidence of nodal disease, elective treatment (RT or surgery ± post-operative RT) is recommended to at least lymph node levels II, III and IV bilaterally. In node positive disease, lymph node levels II-V should be treated on the involved side. (R) • As per the PET-Neck clinical trial, patients with N2 or N3 neck disease who undergo treatment with chemoradiotherapy to their laryngeal primary and experience a complete response with a subsequent negative post-treatment positron emission tomography combined with computed tomography (PET-CT) scan do not require an elective neck dissection. In contrast, patients who have a partial response to treatment or have increased uptake on a post-treatment PET-CT scan should have a neck dissection. (R) • Larynx preservation with concurrent chemoradiotherapy should be considered for T4 tumours, unless there is tumour invasion through cartilage into the soft tissues of the neck, in which case total laryngectomy yields better outcomes. (R) • In the absence of clinical or radiological evidence of nodal disease, elective treatment (RT or surgery ± post-operative RT) is recommended to bilateral lymph node levels II, III, IV, V and VI. (R).

Long-Term Outcomes for Head and Neck Cancer Patients With N3 Neck Disease

Long-Term Outcomes for Head and Neck Cancer Patients With N3 Neck Disease

Lymph Node Metastasis in T4 Maxillary Sinus Squamous Cell Carcinoma: Incidence and Treatment Outcome

The purpose of this study was to evaluate the incidence of lymph node metastasis among patients with T4 maxillary sinus squamous cell carcinoma (MS-SCC) as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. Consecutive series of all patients (n = 128) with previously untreated T4 maxillary sinus SCC between 2006 and 2007 were obtained from 28 institutions belonging to or cooperating in the Head and Neck Cancer Study Group of the Japan Clinical Oncology Group. Of the 128 patients, 28 (21.9 %) had lymph node metastasis, and six patients (4.7 %) had distant metastasis at diagnosis. Among the 111 patients who were treated with curative intent, 98 had clinically N0 neck disease and did not receive prophylactic neck irradiation. A total of 11 patients (11.2 %) subsequently developed evidence of lymph node metastasis, of whom eight were among the 83 patients with an N0 neck and had not received elective neck treatment. There were 15 patients who received an elective neck dissection as part of the initial treatment, of whom three had pathologically positive for lymph node metastases. Of 11 patients, six patients with nonlateral retropharyngeal lymph node metastasis without primary or distant disease were successfully salvaged. This study identified the incidence of lymph node metastasis among patients with T4 MS-SCC as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. These results will be of assistance in selecting treatment strategy for T4 MS-SCC in the future.

Pretreatment SUV of the metastatic neck lymph nodes predicts neck control and survival in patients with stage IV oro/hypopharyngeal cancers

Purpose To investigate the prognostic significance of standardized uptake value (SUV) of metastatic neck lymph nodes measured on FDG PET/CT in patients with stage IV oro/hypopharyngeal cancers treated by definitive chemoradiotherapy (CCRT).Methods Retrospective analysis of 65 patients with clinically N+ stage IV SCC of the oro/hypopharyngeal squamous cell carcinoma (SCC) who underwent FDG PET/CT scans for primary staging. Follow-up continued till death or at least 24 months from the start of treatment. The primary study endpoint was neck control (NC). The log-rank test and Cox proportional hazard analysis were used to identify significant prognostic factors.Results The 3-year NC rate was 53%. In univariate analysis, N3 status and nodal SUV ≥ 9.8 were significantly associated with reduced NC. In multivariable analyses, nodal SUV retained its independent prognostic significance as a predictor of NC. Lymph node stage was an independent predictor of disease specific survival (DSS). A prognostic scoring system was constructed as follows: score 0 = N0-N2 and nodal SUV < 9.8; score 1 = N3 or nodal SUV ≥ 9.8; and score 2 = N3 and nodal SUV ≥ 9.8. Patients with a score of 2 showed the worst NC (hazard ratio [HR], 95% confidence interval [CI] = 10.5, 3.3-33.1; P < 0.001) and the lowest DSS (HR, 95% CI = 6.4, 2.2-18.7; P = 0.001).Conclusion The combination of high nodal SUV and N3 neck disease identifies a subgroup of high-risk stage IV oro/hypopharyngeal SCC patients. Further prospective studies are warranted to validate this finding.

Outcomes of head and neck squamous cell carcinoma patients with N3 neck disease treated primarily with chemoradiation versus surgical resection

Although treatment paradigms have shifted to recommend primary chemoradiation therapy (CRT) for advanced head and neck squamous cell carcinoma, few studies include any significant number of patients with N3 (>6 cm) neck disease. The objective of this study was to determine if primary chemoradiation therapy has equivalent overall survival (OS) and disease-free survival (DFS) when compared to primary surgical resection in patients with N3 neck disease. Nonrandomized, single-institution, retrospective cohort study. Retrospective analysis of 100 patients treated for HNSCC with N3 neck disease between 1989 and 2009 was performed. Patients who received primary surgery had better OS and DFS than those who had primary chemoradiation (P = .047), with a 5-year OS of 68% (95% confidence interval [CI], 45%-84%) versus 32% (95% CI, 19%-45%), and a 5-year DFS of 64% (95% CI, 41%-80%) versus 32% (95% CI, 19%-45%). Neck dissection following primary treatment with CRT did not improve OS. For patients with nonoropharyngeal squamous cell carcinoma with N3 neck disease, those who underwent primary surgery (n = 14) had significantly better OS than those who had primary CRT (n = 32, P = .02). Patients with oropharyngeal disease had better outcomes than other sites regardless of treatment modality, with 5-year OS of 54% (95% CI, 38%-68%) versus 32% (95% CI, 17%-47%, P = .02), but there was no statistical difference between patients treated with primary surgery versus CRT. Patients with head and neck squamous cell cancer and N3 neck disease have at least equivalent survival with primary surgical treatment versus primary CRT. Primary surgical resection with appropriate adjuvant therapy should be considered for patients with resectable N3 disease, especially patients with nonoropharyngeal sites. Post-CRT neck dissections did not change the OS of patients with N3 disease.

Wound Complication in Post‐chemoradiotherapy Neck Dissection

Objective: Report the incidence and type of postoperative complications following neck dissection in patients with advanced stage squamous cell cancer of the laryngopharynx treated with chemoradiotherapy (CRT) and to identify factors predictive of these complications. Method: Design: Retrospective review of case series. Setting: Single institution. Patients: Thirty-three patients with advanced laryngopharyngeal cancer who underwent postchemoradiation neck dissection between 2003 and 2007 were identified. Intervention: Neck dissection, with or without resection of the primary site, in patients following chemoradiotherapy. Main outcome measure: postoperative complications. Results: Thirty-eight neck dissections were carried out in 33 patients (median ± SD age, 59 ± 7.8 years; 85% male). Local wound complications were recorded in 6 (18%) of 33 patients with one mortality from carotid rupture. Complications were seen in 1 (17%) of 6 patients with N1 disease, 5 (23%) of 22 patients with N2, and 0 of 5 patients with N3 neck disease. There was no association between type of neck dissection, medical comorbidities, smoking, time interval between completion of chemoradiotherapy and neck dissection, and rate of complications ( P &gt; .05). There were no recorded systemic complications following salvage surgery. Conclusion: The incidence of wound complications after neck dissection in patients treated with chemoradiation in our cohort is 18%. This compares favorably to reported literature. Nutritional issues and patients’ co-morbidities should be addressed to minimize wound complications risk.

Results of an Ontario Clinical Oncology Group (OCOG) prospective cohort study on the use of FDG PET/CT to predict the need for neck dissection following radiation therapy of head and neck cancer (HNC).

5504 Background: A significant proportion of node-positive HNC patients will have residual nodes visible on CT following curative radiation therapy +/- concurrent chemotherapy (RT+/-Chemo). A third of these will harbor residual cancer and can be cured by neck dissection (ND). This study examines the ability of PET/CT to detect residual nodal cancer following RT+/-Chemo in HNC patients. Methods: This prospective multi-center study was conducted at 4 regional cancer centers in Ontario. Eligible patients had squamous cell carcinomas with N2 or N3 neck disease. They were treated curatively with RT+/-Chemo to include full radiation dose to nodes deemed involved by tumor. Contrast enhanced CT scans and PET/CT were performed prior to and 8-10 weeks following RT+/-Chemo. Patients with residual nodes >1cm axial dimension on CT were mandated to undergo ND within 4 weeks of imaging. The pathologic results of ND were correlated with post treatment imaging. Patients were followed for neck recurrence for 2 years. Resul...

Extensive Neck Node Metastases (N3) in Head and Neck Squamous Carcinoma

Head and neck squamous cell carcinoma (HNSCC) patients with N3 neck disease at presentation are the minority. Prognosis for such patients is poor, but there is disagreement about which treatment policy is best adopted. The aim of this study was to identify which groups of patients are best offered radical treatment, examining factors of association, prognosis, and survival. Prospective cohort study. Regional tertiary head and neck cancer unit. Data were collected prospectively from patients treated for HNSCC with N3 nodal disease between 1975 and 2005. The data collected included age, sex, tumor TNM stage, histological grade, treatment, and survival. Odds ratio was used to calculate whether each parameter was statistically significant. Tumor-specific and observed survival curves were also calculated. A total of 275 patients had N3 disease. Multivariate analysis confirmed that advanced disease at the primary site (odds ratio = 4.6, P = .0261) mitigated against curative treatment. Comparison of tumor-specific survival between curative and palliative treatment strategies suggests that aggressive treatment is associated with greatly improved survival (median survival = 1.45 years, 95% confidence interval [CI] = 1.23-1.67 years; 5-year survival = 26.6%, CI = 17.14%-36.06%) compared with those treated palliatively (median survival = 3.18 months, CI = 3.06-3.30 months; no 5-year survivors; P < .0001). A major factor in determining treatment strategies for N3 disease HNSCC is the extent of disease at the primary site. These data suggest that aggressive treatment of the neck improves survival and should be considered in these patients.

Outcome With Neck Dissection After Chemoradiation for N3 Head-and-Neck Squamous Cell Carcinoma

To evaluate the role of neck dissection (ND) after chemoradiation therapy (CRT) for head and neck squamous cell carcinoma (HNSCC) with N3 disease. From March 1998 to September 2006, 70 patients with HNSCC and N3 neck disease were treated with concomitant CRT as primary therapy. Response to treatment was assessed using clinical examination and computed tomography 6 to 8 weeks posttreatment. Neck dissection was not routinely performed and considered for those with less than complete response. Of the patients, 26 (37.1%) achieved clinical complete response (cCR) after CRT. A total of 31 (44.3%) underwent ND after partial response (cPR-ND). Thirteen patients (29.5%) did not achieve cCR and did not undergo ND for the following reasons: incomplete response/progression at primary site, refusal/contraindication to surgery, metastatic progression, or death. These patients were excluded from the analysis. Outcomes were computed using Kaplan-Meier curves and were compared with log rank tests. Comparing the cCR and cPR-ND groups at 2 years, the disease-free survival was respectively 62.7% and 84.9% (p = 0.048); overall survival was 63.0% and 79.4% (p = 0.26), regional relapse-free survival was 87.8% and 96.0% (p = 0.21); and distant disease-free survival was 67.1% and 92.6% (p = 0.059). In the cPR-ND group, 71.0% had no pathologic evidence of disease (PPV of 29.0%). Patients with N3 disease achieving regional cPR and primary cCR who underwent ND seemed to have better outcomes than patients achieving global cCR without ND. Clinical assessment with computed tomography is not adequate for evaluating response to treatment. Because of the inherent limitations of our study, further confirmatory studies are warranted.

Role of chest CT in staging of oropharyngeal cancer: A systematic review

The prevalence of synchronous or metastatic tumors in patients with head and neck squamous cell carcinoma (HNSCC) ranges from 6% to 20% and has implications for prognosis and management of the primary disease. There is no consensus about the role of chest CT prior to definitive treatment patients with HNSCC. A systematic review of all chest CT studies in relation to HNSCC was performed, together with a review of our local database. Twenty-four studies were identified in addition to our local data. Prevalence of positive chest CT was 7.93%. Patients were significantly more likely to have a positive chest CT with N2 or N3 neck disease (p = .0062) and stage III or IV disease (p = .0001), and significantly less likely with tumors of the oral cavity (p = .0007). We advocate chest CT as part of the initial investigations for patients with HNSCC.

Positive Sentinel Lymph Nodes are a Negative Prognostic Factor for Survival in T1–2 Oral/Oropharyngeal Cancer: A Long-Term Study on 103 Patients

Detection and treatment of occult nodal metastasis and management of the clinically N0 neck have posed a challenge in head and neck squamous cell carcinoma (HNSCC). In an attempt to translate successful staging strategies employed in breast carcinoma and melanoma, sentinel node biopsy (SNB) has been investigated in the context of HNSCC over the past decade. The concept of sentinel node biopsy relies on the theory that the firstechelon node/s (sentinel node) will harbor the lymphatic flow from the tumor, and pathologic evaluation of this node will accurately reflect the nodal staging. In particular, early-stage oral-cavity and oropharyngeal cancers have been targeted for studies evaluating the utility of sentinel node biopsy, and the incidence of occult metastatic disease to the cervical lymph nodes is approximately 20–30% in low-stage oral-cavity cancers. Most investigations have focused on the possibility that accurate SNB may facilitate avoidance of staging neck dissections, particularly in patients with low-stage T1–2 oral-cavity cancer that would avoid postoperative radiotherapy with low-risk primary tumor and pathologically negative neck. In this issue, Kovacs et al. address the prognostic value of sentinel lymph node biopsy in oral/oropharyngeal squamous cell carcinoma. With a moderate sample size of 103 patients, they reported no false negatives, and poor prognostic associations with patients that had a positive sentinel node. Although encouraging, there are several unique characteristics of this study that make it difficult to extrapolate these findings to routine clinical practice: (1) the use of intra-arterial high-dose chemotherapy given 3–4 weeks prior to surgery for primary cancer is not widely adopted, and may have variable effects on clinical disease outcomes, lymphatic drainage patterns, or impacted micrometastatic spread to draining lymph nodes, (2) uniform use of fluorodeoxyglucose positron emission tomography (FDG-PET) may have stage-shifted patients such that the study population was enriched for pathologic N0 neck disease, and resulted in the low upstaging rate reported by these authors as compared with other published data. The prognostic significance of a positive sentinel node reported in this study is difficult to assess in a larger context as well because: (1) planned postoperative radiation was employed for patients with a T2 primary tumor with an N0 neck, a practice not uniformly applied, (2) only 1/9 patients who were upstaged by positive SNB actually received postoperative radiation, a usual standard of care, and (3) the reported diameter of all the positive nodes was C10 mm and the diameter of the metastasis averaged 4.6 mm; it is unclear why these nodes did not fulfill computed tomography (CT) size criteria (1.0 cm) that designate a pathologic node. A recent large meta-analysis in HNSCC conducted by Paleri et al. estimated a detection rate of 90% and a falsenegative rate of 10% for SNB. Although a false-negative rate of zero is reported by Kovacs et al., there were two patients who developed contralateral neck metastasis and one patient with submandibular gland cancer of unreported histology, reflecting a lack of consensus regarding the definition of a false-negative SNB in HNSCC. Of note, in two recent series evaluating SNB it was demonstrated that unanticipated contralateral sentinel lymph nodes can occur in 15–20% of patients. Society of Surgical Oncology 2008

Diagnostic accuracy of 99mTc-MIBI-SPECT in the detection of lymph node metastases in patients with carcinoma of the tongue: comparison with computed tomography and MRI

To compare the diagnostic efficacy of computerized tomography (CT), magnetic resonance imaging (MRI), and Tc-methoxyisobutylisonitrile-single photon emission computed tomography (MIBI-SPECT) for the detection of lymph node (LN) metastases in clinically neck-negative patients (T1-T2N0) with carcinoma of the tongue. Twenty adult patients (aged 54.75+/-14.57 years) with histopathologically proven carcinoma of the tongue and clinically neck-negative (T1-T2N0) status were included in this study. Before the wide local excision of the primary tumor followed by modified functional neck dissection, all the patients underwent contrast-enhanced CT and MRI and 99mTc-MIBI-SPECT. The SPECT data acquisition (3600 arc, 128 x 128 matrix, 64 projections, 20 s/projection) was performed 15 min after an intravenous injection of 555-740 MBq of 99mTc-MIBI under the dual head gamma-camera (E Cam, Siemens, Erlangen, Germany) using the low-energy, high-resolution, parallel hole collimator. SPECT data reconstruction was achieved by filtered back projection using the Butterworth filter with a critical frequency of 0.5 and power 10.0. Only visual assessment was used for defining a positive lymph nodes (LNs) on reconstructed SPECT images and maximum intensity projection images. Histopathological examination of LNs was performed using hematoxylin and eosin staining. A total of 351 LNs were excised surgically (functional neck dissection) from 20 tongue cancer patients having N0 neck disease. Only nine of 351 LNs were documented as being positive for malignancy on histopathological examination. These nine LNs were distributed in eight of 20 patients. CT, MRI, and MIBI-SPECT could accurately identify one, three, and five LNs, respectively. In one of the eight patients, 99mTc-MIBI-SPECT could not distinguish between two LNs present at the same level, having size of 6.0 and 8.0 mm. In this study, 99mTc-MIBI-SPECT was shown to have better sensitivity/positive predictive values (55.5%/71%) than either CT (11%/33%) or MRI (33%/60%). The histopathologically documented metastatic LNs picked up by CT or MRI were also identified by 99mTc-MIBI-SPECT. In this preliminary prospective study, we observed that 40% (8/20) of the clinically neck-negative carcinoma tongue patients harbored metastatic LNs. 99mTc-MIBI-SPECT is a more effective imaging modality in the staging of clinically neck-negative LN metastases in carcinoma tongue as compared with CT or MRI.

Path-Positive Specimens in Post ChemoRT Neck Dissections

Objective To determine the likelihood of pathologically positive neck dissections after primary chemoradiotherapy for advanced squamous cell carcinoma (SCC) of the head and neck, and to examine the impact of persistent neck disease on regional recurrence, distant metastasis, and survival. Methods 57 patients with N2 and N3 neck disease undergoing primary chemoradiotherapy for SCC of the oral cavity, oropharynx, larynx, and hypopharynx who underwent post-treatment neck dissections (PND) from 1999–2007 at the University of Illinois Chicago were evaluated for clinical complete response (CCR) and pathologic complete response (PCR). CCR was determined by physical examination (PE) and CT findings performed 4 to 6 weeks after chemoradiotherapy. Positive predictive value (PPV) was defined as CCR predictive of PCR. We also determined the impact of pathologically positive PND on surgical complications, regional recurrence, distant metastasis, disease-free survival, and overall survival using the chi-squared and log-rank tests. Results Of the 57 patients who underwent neck dissections, 17 (30%) had pathologically positive neck dissection specimens. When PE and CT findings showed resolution of disease (CCR), 85% (PPV) of pathologic specimens demonstrated no residual cancer. Conversely, when CCR was not achieved, 40% (NPV) of pathologic specimens demonstrated residual cancer. Positive pathologic disease in PND was associated with worse overall survival (p=0.014). Conclusions Persistent neck disease is common in advanced head and neck patients undergoing primary chemoradiotherapy. Failure to achieve CCR increases the likelihood of pathologically positive neck specimens by more than two-fold.

Outcomes of Patients with N3 Neck Nodes Treated with Chemoradiation

To evaluate the outcomes of patients with locally advanced head and neck squamous cell carcinoma with N3 neck nodes treated with definitive chemoradiation. Retrospective review. Thirty-two patients with nonmetastatic locally advanced head and neck squamous cell carcinoma and N3 neck disease treated with concurrent chemoradiation therapy were evaluated. Overall survival, disease- free survival, locoregional control, and distant control were recorded. Median follow-up for surviving patients was 25 (range, 3-93) months. Seventeen of 32 (53%) patients failed, 13 in distant sites only, 2 in the neck only, 1 in the neck and a distant site, and 1 in the neck and primary site. The absolute rates of locoregional control and distant control were 88% and 56%, respectively. Actuarial overall survival and disease-free survival at 2 years were 51% and 29%, respectively. Patients with N3 neck disease treated with chemoradiation experience a very high rate of distant failure. Future studies investigating the role of additional systemic therapy in these patients are warranted.

Organ Preserving Transoral Laser Microsurgery for Cancer of the Hypopharynx

To assess the feasibility of transoral laser microsurgery (TLM) in the treatment of hypopharyngeal cancer, with a special focus on piriform sinus carcinomas, and to report the oncologic and functional outcomes. Prospective case-series study at a single institute, an academic tertiary referral center. A total of 172 patients with previously untreated squamous cell carcinoma of the hypopharynx were eligible for this study (1986-2003). The piriform sinus was the most common localization (n = 150). Patients with simultaneous second primaries, distant metastases, or N3 neck disease and cancers of the category pT4b were excluded. Fifteen percent of the patients had stages I and II (according to guidelines from the Union Internationale Contre le Cancer 2002/American Joint Commission on Cancer, 2002), and 85% had stages III and IVa. The median follow-up period was 45 months. All patients (n = 172) were treated by TLM, mainly by selective neck dissection (93%) and/or postoperative radiotherapy (52%). Overall survival, recurrence-free survival, organ preservation, and local control were analyzed as end points. Rate of tracheotomies, postoperative complications, and swallowing function (feeding tube dependency) were also analyzed. : Five-year Kaplan-Meier local control was 84% for pT1; 70% for pT2; 75% for pT3; and 57% for pT4a. Five-year Kaplan-Meier recurrence-free survival was 73% for stages I and II, 59% for stage III, and 47% for stage IVa. The whole group of 172 hypopharyngeal cancer patients was analyzed, with an additional special focus on the homogenous group of piriform sinus carcinomas (n = 150). Our data support the conclusion that TLM is a valid option to standard radical surgery or standard conservation treatment. Oncologic and functional results compare favorably, while morbidity and complication rates tend to be lower.

Absence of Planned Neck Dissection for the N2-N3 Neck After Chemoradiation for Locally Advanced Squamous Cell Carcinoma of the Head and Neck

To review our institutional experience of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) and N2-N3 neck disease with respect to neck recurrence after chemoradiation without planned neck dissection (ND). Retrospective study. Tom Baker Cancer Centre, Calgary, Alberta, Canada. Fifty-four adults with locally advanced SCCHN and N2-N3 neck disease. Eighty consecutive patients were treated with chemoradiation, 70 Gy given as 2 Gy daily for 7 weeks, with cisplatin, 20 mg/m(2), given on the first 4 days of weeks 1 and 5. Of the 80 patients, 54 were evaluable. Primary outcomes were overall survival and absence or presence of neck disease after chemoradiation. Secondary outcomes included disease-specific survival and locoregional recurrence-free survival. Median follow-up of living patients was 35 months. Patients with a complete response (CR) did not have any planned ND. Factors associated with the absence of recurrent neck disease included CR (P < .001), younger age (P = .02), and better Karnofsky Performance Status (P = .049). In patients achieving CR, 2-year overall, disease-specific, and locoregional recurrence-free survival was 92%, 95%, and 95%, respectively. Three of the 43 patients (7%) with N2 lesions obtaining CR subsequently experienced a neck recurrence at a median of 15 months (range, 7-24 months). In these patients with locally advanced SCCHN and N2-N3 neck disease treated with chemoradiation and achieving CR, only a few patients with N2 neck disease experienced recurrence despite the absence of planned ND. Prospective trials are needed to identify patients with N2 neck disease who may still benefit from planned ND after chemoradiation. There were not enough patients with N3 neck disease to make any recommendations.

Is Sentinel Node Biopsy A Better Predictor Of Survival Than Conventional Imaging For Patients With T1/T2 Squamous Cell Cancer Of The Oral Cavity And N0 Neck Disease?: Evidence Based Medicine

Predicting the long-term survival of patients diagnosed with oral cavity squamous cell carcinoma who have clinically N0 neck disease is difficult. Traditionally, staging of the neck is performed by physical examination and more recently by the combination of physical exam and the use of conventional imaging studies such as computed axial tomography, ultrasonography or magnetic resonance imaging. These techniques have been shown to be unreliable in detecting very early occult metastatic disease. Sentinel node biopsy (lymphoscintigraphy) is being investigated as tool that would better predict occult neck malignancy in this population. The objective of this study is to document evidence-based information that supports the use of sentinel node biopsy over conventional imaging as a predictor of survival in oral cavity cancer patients with clinically N0 neck disease. An exhaustive literature search targeting evidence-based databases was performed on the topic. After review of the current literature, no sound evidence was discovered to support the use of lymphoscintigraphy over conventional imaging as a predictor of survival in patients with T1/T2 squamous cell carcinoma of the head and neck and N0 neck disease. While this intervention has been found to be reliable in the detection of occult disease, further investigation is needed in the form of randomized clinical trials to appropriately establish this technique as a reliable predictor of survival. A course paper presented to the College of Allied Health and Nursing in partial fulfillment of the requirements for the degree of Doctor of Health Science Nova Southeastern University, March 2007 Abstract of a course paper presented to Nova Southeastern University in partial fulfillment of the requirements for the degree of Doctor of Health Scienceof a course paper presented to Nova Southeastern University in partial fulfillment of the requirements for the degree of Doctor of Health Science

2412: Primary and Post-Operative Radiation Therapy Based on CT Simulation, Functional Outcome, and Larynx Preservation in Squamous Cell Carcinoma of the Tongue Base

2412: Primary and Post-Operative Radiation Therapy Based on CT Simulation, Functional Outcome, and Larynx Preservation in Squamous Cell Carcinoma of the Tongue Base