title: The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer.
abstract: BACKGROUND
  We performed this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, neither of which has been well established to date.
  
  
  METHODS
  Our departmental database was queried for patients irradiated for OPC between 2001 and 2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcome data were retrieved and analyzed.
  
  
  RESULTS
  The cohort consisted of 981 patients. The median follow-up was 69 months. The base of the tongue (47%) and the tonsil (46%) were the most common primary sites. The majority of patients had stage T1 to T2 primary tumors (64%), and 94% had stage 3 to 4B disease. Intensity-modulated radiation therapy was used in 77% of patients, and systemic therapy was administered in 58% of patients. The incidence of radiographic RPLN involvement was 10% and was highest for the pharyngeal wall (23%) and lowest for the base of the tongue (6%). RPLN adenopathy correlated with several patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (P<.001 for all) for local control (79% vs 92%), nodal control (80% vs 93%), recurrence-free survival (51% vs 81%), distant metastases-free survival (66% vs 89%), and overall survival (52% vs 82%) and maintained significance on multivariate analysis for local control (P = .023), recurrence-free survival (P = .001), distant metastases-free survival (P = .003), and overall survival (P = .001).
  
  
  CONCLUSIONS
  In this cohort of nearly 1000 patients investigating [corrected] radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends [corrected] a negative influence on disease recurrence, distant relapse, and survival. In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: G Brandon
authors.initials: GB
authors.lastname: Gunn
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Debnam
authors.forename: Clifton D
authors.initials: CD
authors.lastname: Fuller
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Bonnie S
authors.initials: BS
authors.lastname: Glisson
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D010610:Pharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: incidence; oropharyngeal cancer; radiation therapy; retropharyngeal lymph nodes; survival