Management of the lymph node-positive neck in the patient with human papillomavirus-associated oropharyngeal cancer

Menée sur 401 patients ayant reçu entre 2006 et 2012 une radiothérapie définitive, combinée ou non à une chimiothérapie, pour traiter un cancer oropharyngé associé au papillomavirus humain et présentant un envahissement ganglionnaire (durée médiane de suivi : 30 mois), cette étude rétrospective évalue, du point de vue du taux actuariel de récidive à 2 ans et du taux de récidive ganglionnaire, l'intérêt d'ajouter au traitement un curage ganglionnaire du cou

Résumé en anglais

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. Cancer 2014. © 2014 American Cancer Society.