A.G. and L.G.T.M. contributed equally to this work.
Long-term regional control in the observed neck following definitive chemoradiation for node-positive oropharyngeal squamous cell cancer
Article first published online: 29 MAR 2013
Copyright © 2013 UICC
International Journal of Cancer
Volume 133, Issue 5, pages 1214–1221, 1 September 2013
How to Cite
Goenka, A., Morris, L. G.T., Rao, S. S., Wolden, S. L., Wong, R. J., Kraus, D. H., Ohri, N., Setton, J., Lok, B. H., Riaz, N., Mychalczak, B. R., Schoder, H., Ganly, I., Shah, J. P., Pfister, D. G., Zelefsky, M. J. and Lee, N. Y. (2013), Long-term regional control in the observed neck following definitive chemoradiation for node-positive oropharyngeal squamous cell cancer. Int. J. Cancer, 133: 1214–1221. doi: 10.1002/ijc.28120
- Issue published online: 18 JUN 2013
- Article first published online: 29 MAR 2013
- Accepted manuscript online: 22 FEB 2013 04:30AM EST
- Manuscript Accepted: 9 JAN 2013
- Manuscript Received: 13 SEP 2012
- oropharyngeal squamous cell carcinoma;
- neck dissection;
Traditionally, patients treated with chemoradiotherapy for node-positive oropharyngeal squamous cell carcinoma (N+ OPSCC) have undergone a planned neck dissection (ND) after treatment. Recently, negative post-treatment positron-emission tomography (PET)/computed tomography (CT) imaging has been found to have a high negative predictive value for the presence of residual disease in the neck. Here, we present the first comprehensive analysis of a large, uniform cohort of N+ OPSCC patients achieving a PET/CT-based complete response (CR) after chemoradiotherapy, and undergoing observation, rather than ND. From 2002 to 2009, 302 patients with N+ OPSCC treated with 70 Gy intensity-modulated radiation therapy and concurrent chemotherapy underwent post-treatment clinical assessment including PET/CT. CR was defined as no evidence of disease on clinical examination and post-treatment PET/CT. ND was reserved for patients with <CR on either PET/CT, clinical examination, or other imaging. 260 patients (86.1%) had clinical and radiographic CRs, and underwent neck observation (rate of regional control, 97.7%; 5-year overall survival, 79.8%). The four observed patients experiencing neck recurrence had initial staging of N1 (n = 2), N2b (n = 1), and N2c (n = 1). Three of four were successfully surgically salvaged. There was no association between N stage and rate of neck recurrence (p = 0.74). 52 and 25% of patients undergoing ND had viable tumor in the neck after positive and negative PET/CT, respectively. We conclude that patients achieving CRs after chemoradiation, based on clinical and PET/CT assessment, have a high probability of regional control, with a 2.3% regional failure rate, and may be safely observed without planned ND.