title: Management of the lymph node-positive neck in the patient with human papillomavirus-associated oropharyngeal cancer.
abstract: BACKGROUND
  The goal of the current study was to assess the rates of recurrence in the neck for patients with lymph node-positive human papillomavirus-associated cancer of the oropharynx who were treated with definitive radiotherapy (with or without chemotherapy).
  
  
  METHODS
  This is a single-institution retrospective study. Methodology included database search, and statistical testing including frequency analysis, Kaplan-Meier tests, and comparative tests including chi-square, logistic regression, and log-rank.
  
  
  RESULTS
  The cohort consisted of 401 patients with lymph node-positive disease who underwent radiotherapy between January 2006 and June 2012. A total of 388 patients had computed tomography restaging, and 251 had positron emission tomography and/or ultrasound as a component of their postradiation staging. Eighty patients (20%) underwent neck dissection, and 21 patients (26%) had a positive specimen. The rate of neck dissection increased with increasing lymph node stage, and was lower in patients who had positron emission tomography scans or ultrasound in addition to computed tomography restaging. The median follow-up was 30 months. The 2-year actuarial neck recurrence rate was 7% and 5%, respectively, in all patients and those with local control. Lymph node recurrence rates were greater in current smokers (P = .008). There was no difference in lymph node recurrence rates noted between patients who did and those who did not undergo a neck dissection (P = .4) CONCLUSIONS: A treatment strategy of (chemo)radiation with neck dissection performed based on response resulted in high rates of regional disease control in patients with human papillomavirus-associated oropharyngeal cancer.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.forename: Gary B
authors.initials: GB
authors.lastname: Gunn
authors.forename: Amy
authors.initials: A
authors.lastname: Hessel
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.forename: Salmaan
authors.initials: S
authors.lastname: Ahmed
authors.forename: Adel K
authors.initials: AK
authors.lastname: El-Naggar
authors.forename: Clifton D
authors.initials: CD
authors.lastname: Fuller
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Byers
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Merill S
authors.initials: MS
authors.lastname: Kies
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052685:Alphapapillomavirus; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D049268:Positron-Emission Tomography; D018714:Radiotherapy, Adjuvant; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: human papillomavirus (HPV); intensity-modulated radiotherapy (IMRT); neck dissection; oropharyngeal cancer