title: Long-term regional control in the observed neck following definitive chemoradiation for node-positive oropharyngeal squamous cell cancer.
abstract: 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.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. anuj.goenka@gmail.com
authors: Anuj
authors: A
authors: Goenka
authors: Luc G T
authors: LG
authors: Morris
authors: Shyam S
authors: SS
authors: Rao
authors: Suzanne L
authors: SL
authors: Wolden
authors: Richard J
authors: RJ
authors: Wong
authors: Dennis H
authors: DH
authors: Kraus
authors: Nisha
authors: N
authors: Ohri
authors: Jeremy
authors: J
authors: Setton
authors: Benjamin H
authors: BH
authors: Lok
authors: Nadeem
authors: N
authors: Riaz
authors: Borys R
authors: BR
authors: Mychalczak
authors: Heiko
authors: H
authors: Schoder
authors: Ian
authors: I
authors: Ganly
authors: Jatin P
authors: JP
authors: Shah
authors: David G
authors: DG
authors: Pfister
authors: Michael J
authors: MJ
authors: Zelefsky
authors: Nancy Y
authors: NY
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009333:Neck; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D027383:Papillomaviridae / Q000302:isolation & purification; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
keywords: PET; neck dissection; observation; oropharyngeal squamous cell carcinoma