Abstract
Non-surgical therapy consisting of external beam radiation with or without chemotherapy is an effective treatment for patients with squamous cell carcinoma (SCC) of the oropharynx with advanced neck disease (N2a or greater). However, many of these patients have to undergo a neck dissection for clinically persistent regional disease. It is reported that nearly 50% of the neck dissection specimens contain residual viable tumor cells that may indicate partial radiation failure and as a consequence poor survival. In order to address the significance of this finding, we conducted a nonrandomized retrospective study, including 35 patients who underwent definitive radiation therapy followed by either a radical or modified radical (RND/MRND) or a selective neck dissection (SND) for clinically persistent neck disease 6 weeks after completing therapy for stage III/IV SCC of the oropharynx (base of the tongue =15, tonsil =12, soft palate =7 and pharyngeal wall =1). All neck dissection specimens were reviewed according to histological criteria indicating viable residual tumor. We observed an increased relative risk (RR) for local and regional failures in the patient population with viable cancer cells in the post-irradiation neck specimens (RR=6.7 and 4.1, respectively). The presence of malignant tumor cells in residual disease in the neck correlated with poor disease-specific and overall survival ( P =0.03 and P =0.01, respectively). Of note, the extent of neck dissection did not improve the disease-free or overall survival in this patient population ( P =0.5 and P =0.6, respectively). In conclusion, the presence of viable cancer cells in radiated neck nodes is a novel prognostic marker for disease-specific survival in patients treated for SCCs of the oropharynx with advanced neck disease and may serve as an identifier for patients who will benefit from post-treatment chemoprevention.
Similar content being viewed by others
References
(1991) Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med 324:1685–1690
Barkley HT Jr, Fletcher GH, Jesse RH, Lindberg RD (1972) Management of cervical lymph node metastases in squamous cell carcinoma of the tonsillar fossa, base of tongue, supraglottic larynx, and hypopharynx. Am J Surg 124:462–467
Boyd TS, Harari PM, Tannehill SP, Voytovich MC, Hartig GK, Ford CN, Foote RL, Campbell BH, Schultz CJ (1998) Planned postradiotherapy neck dissection in patients with advanced head and neck cancer. Head Neck 20:132–137
Doweck I, Robbins KT, Mendenhall WM, Hinerman RW, Morris C, Amdur R (2003) Neck level-specific nodal metastases in oropharyngeal cancer: is there a role for selective neck dissection after definitive radiation therapy? Head Neck 25:960–967
Fein DA, Lee WR, Amos WR, Hinerman RW, Parsons JT, Mendenhall WM, Stringer SP, Cassisi NJ, Million RR (1996) Oropharyngeal carcinoma treated with radiotherapy: a 30-year experience. Int J Radiat Oncol Biol Phys 34:289–296
Huang DT, Johnson CR, Schmidt-Ullrich R, Grimes M (1992) Postoperative radiotherapy in head and neck carcinoma with extracapsular lymph node extension and/or positive resection margins: a comparative study. Int J Radiat Oncol Biol Phys 23:737–742
Lavertu P, Bonafede JP, Adelstein DJ, Saxton JP, Strome M, Wanamaker JR, Eliachar I, Wood BG (1998) Comparison of surgical complications after organ-preservation therapy in patients with stage III or IV squamous cell head and neck cancer. Arch Otolaryngol Head Neck Surg 124:401–406
Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T (1996) Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst 88:890–899
Machtay M, Rosenthal DI, Hershock D, Jones H, Williamson S, Greenberg MJ, Weinstein GS, Aviles VM, Chalian AA, Weber RS (2002) Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a University of Pennsylvania Phase II Trial. J Clin Oncol 20:3964–3971
Mendenhall WM, Parsons JT, Stringer SP, Cassisi NJ, Million RR (1992) Squamous cell carcinoma of the head and neck treated with irradiation: management of the neck. Semin Radiat Oncol 2:163–170
Narayan K, Crane CH, Kleid S, Hughes PG, Peters LJ (1999) Planned neck dissection as an adjunct to the management of patients with advanced neck disease treated with definitive radiotherapy: for some or for all? Head Neck. 21:606–613
Parsons JT, Mendenhall WM, Stringer SP, Amdur RJ, Hinerman RW, Villaret DB, Moore-Higgs GJ, Greene BD, Speer TW, Cassisi NJ, Million RR (2002) Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both. Cancer 94:2967–2980
Roy S, Tibesar RJ, Daly K, Pambucian S, Lee HK, Gapany M, Adams GL (2002) Role of planned neck dissection for advanced metastatic disease in tongue base or tonsil squamous cell carcinoma treated with radiotherapy. Head Neck 24:474–481
Tsao AS, Kim ES, Hong WK (2004) Chemoprevention of cancer. CA Cancer J Clin 54:150–180
Urba SG, Wolf GT, Bradford CR, Thornton AF, Eisbruch A, Terrell JE, Carpenter V, Miller T, Tang G, Strawderman M (2002) Neoadjuvant therapy for organ preservation in head and neck cancer. Laryngoscope 110:2074–2080
Vikram B, Strong EW, Shah JP, Spiro R (1984) Failure in the neck following multimodality treatment for advanced head and neck cancer. Head Neck Surg 6:724–729
Wong CS, Ang KK, Fletcher GH, Thames HD, Peters LJ, Byers RM, Oswald MJ (1989) Definitive radiotherapy for squamous cell carcinoma of the tonsillar fossa. Int J Radiat Oncol Biol Phys 16:657–662
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Simon, C., Goepfert, H., Rosenthal, D.I. et al. Presence of malignant tumor cells in persistent neck disease after radiotherapy for advanced squamous cell carcinoma of the oropharynx is associated with poor survival. Eur Arch Otorhinolaryngol 263, 313–318 (2006). https://doi.org/10.1007/s00405-005-1016-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-005-1016-0