Karlijn van den Bovenkamp1, Bart Dorgelo2, Maartje G Noordhuis3, Bernard F A M van der Laan3, Bert van der Vegt4, Hendrik P Bijl5, Jan L Roodenburg6, Boukje A C van Dijk7, Sjoukje F Oosting8, Ed M D Schuuring4, Johannes A Langendijk5, Gyorgy B Halmos3, Boudewijn E C Plaat3. 1. Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. Electronic address: k.van.den.bovenkamp@umcg.nl. 2. Department of Radiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. 3. Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. 4. Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. 5. Department of Radiotherapy, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. 6. Department of Oral and Maxillofacial Surgery, Section of Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. 7. Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands; Comprehensive Cancer Organisation The Netherlands (IKNL), P.O. Box 19.079, 3501DB Utrecht, The Netherlands. 8. Department of Medical Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
Abstract
OBJECTIVES: To identify predictive factors for the presence of viable tumor and outcome in head and neck cancer patients who undergo therapeutic salvage neck dissections. MATERIALS AND METHODS: Retrospective analysis of 76 salvage neck dissections after radiotherapy alone (n = 22), radiotherapy in combination with carboplatin/5-fluorouracil (n = 42) or with cetuximab (n = 12). RESULTS: Viable tumor was detected in 41% of all neck dissections. Univariate analysis revealed initial treatment with radiotherapy without systemic therapy (OR 6.93, 95%CI: 2.28-21.07, p < .001), increased lymph node size after initial treatment compared to pretreatment CT scan (OR 20.48, 95%CI: 2.46-170.73, p = .005), more extensive neck dissections (OR 8.40, 95%CI: 2.94-23.98, p < .001), and human papillomavirus negative cancer (OR 4.22, 95%CI: 1.10-16.22, p = .036) as predictors of viable tumor. Patients with decreased or stable, but persistently enlarged lymph node size after chemoradiation had a significantly lower chance of viable tumor (OR 0.15, 95%CI: 0.05-0.41, p < .001). Disease-specific 5-year survival was 34% in case of viable tumor, and 78% when no viable tumor was found (p < .001). CONCLUSIONS: Viable tumor in salvage neck dissections is associated with reduced survival. Radiotherapy alone, human papillomavirus negative cancer and increase in lymph node size, are associated with viable tumor in salvage neck dissections. In case of decreased or stable lymph node size after chemoradiation, watchful waiting could be considered.
OBJECTIVES: To identify predictive factors for the presence of viable tumor and outcome in head and neck cancerpatients who undergo therapeutic salvage neck dissections. MATERIALS AND METHODS: Retrospective analysis of 76 salvage neck dissections after radiotherapy alone (n = 22), radiotherapy in combination with carboplatin/5-fluorouracil (n = 42) or with cetuximab (n = 12). RESULTS: Viable tumor was detected in 41% of all neck dissections. Univariate analysis revealed initial treatment with radiotherapy without systemic therapy (OR 6.93, 95%CI: 2.28-21.07, p < .001), increased lymph node size after initial treatment compared to pretreatment CT scan (OR 20.48, 95%CI: 2.46-170.73, p = .005), more extensive neck dissections (OR 8.40, 95%CI: 2.94-23.98, p < .001), and human papillomavirus negative cancer (OR 4.22, 95%CI: 1.10-16.22, p = .036) as predictors of viable tumor. Patients with decreased or stable, but persistently enlarged lymph node size after chemoradiation had a significantly lower chance of viable tumor (OR 0.15, 95%CI: 0.05-0.41, p < .001). Disease-specific 5-year survival was 34% in case of viable tumor, and 78% when no viable tumor was found (p < .001). CONCLUSIONS: Viable tumor in salvage neck dissections is associated with reduced survival. Radiotherapy alone, human papillomavirus negative cancer and increase in lymph node size, are associated with viable tumor in salvage neck dissections. In case of decreased or stable lymph node size after chemoradiation, watchful waiting could be considered.
Authors: Alfredo Páez-Carpio; Santiago Medrano-Martorell; Joan Berenguer; Africa Muxí; Isabel Vilaseca; Izaskun Valduvieco; Paola Castillo; Neus Baste; F Xavier Avilés-Jurado; Juan José Grau; Laura Oleaga Journal: Eur Arch Otorhinolaryngol Date: 2022-10-01 Impact factor: 3.236
Authors: Jeroen E van Schaik; Saskia H Hanemaaijer; György B Halmos; Max J H Witjes; Bernard F A M van der Laan; Bert van der Vegt; Boudewijn E C Plaat Journal: Otolaryngol Head Neck Surg Date: 2020-06-30 Impact factor: 3.497
Authors: Saskia H Hanemaaijer; Maran Fazzi; Roel J H M Steenbakkers; Bart Dorgelo; Bert van der Vegt; Max J H Witjes; Bernard F A M van der Laan; Sjoukje F Oosting; Gilles N Stormezand; Boudewijn E C Plaat Journal: Clin Otolaryngol Date: 2020-05-25 Impact factor: 2.597