title: Control of nodal metastases in squamous cell head and neck cancer treated by radiation therapy or chemoradiation.
abstract: OBJECTIVE
  In the present study, prognostic values of several CT-based pre-treatment nodal and treatment-related characteristics were evaluated among patients with squamous cell head and neck cancer treated with non-surgical modalities.
  
  
  METHODS
  Included were 79 patients with 210 pathological nodes, who underwent primary irradiation or chemoradiation. Several nodal characteristics were assessed on the planning CT scan. In addition, the 3D-dose distribution in the nodes was calculated by the planning system to allow for evaluation of underdosage in the pathological nodes and to correlate these results with control in the neck. Analysis was done on patient level (regional control) and node level (nodal control).
  
  
  RESULTS
  For regional control, total nodal volume and the use of chemotherapy in addition to radiation were significant prognostic factors. For nodal control, also the presence of central necrosis and radiological extranodal spread were of importance. In case of radiotherapy alone, a minimal dose <95% of the prescribed dose was associated with worse control. In case of combined modality treatment, the minimal radiation dose was of less importance.
  
  
  CONCLUSIONS
  Nodal volume and chemotherapy are the most important prognostic factors to control pathological nodes in the neck. Radiological central necrosis and extranodal growth, nodal volume and chemotherapy were significant prognostic factors for nodal control. Additionally, it appears that regional control in patients treated with primary radiation alone or with chemoradiation in case of a total nodal volume of more than 3.0 cm(3) results in an unacceptable high risk on regional recurrence.
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. mr.vergeer@vumc.nl
authors.forename: Marije R
authors.initials: MR
authors.lastname: Vergeer
authors.forename: Patricia
authors.initials: P
authors.lastname: Doornaert
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.forename: Jan
authors.initials: J
authors.lastname: Buter
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D005069:Evaluation Studies as Topic; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin