Karolina A Plonowska1, Madeleine P Strohl2, Steven J Wang3, Patrick K Ha4, Jonathan R George4, Chase M Heaton4, Ivan H El-Sayed4, Jon Mallen-St Clair5, William R Ryan4. 1. 1 School of Medicine, University of California-San Francisco, San Francisco, California, USA. 2. 2 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA. 3. 3 Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Phoenix, Arizona, USA. 4. 4 Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA. 5. 5 Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
Abstract
OBJECTIVE: To characterize patterns of neck lymph node (LN) metastases in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma, represented by p16 positivity (p16+OPSCC). STUDY DESIGN: Case series with chart review. SETTING: Tertiary care center. SUBJECTS AND METHODS: Neck dissection (ND) specimens of nonirradiated p16+OPSCC patients were analyzed for frequencies of clinically evident and occult LNs by neck level. Local, regional, and distant recurrences were reviewed. RESULTS: Seventy p16+OPSCC patients underwent primary site transoral robotic surgery and 82 NDs of varying levels. Metastatic pathologic LNs were found at the following frequencies: 0% (0/28) in level I, 75.6% (62/82) in level II with 57.4% (35/61) in level IIA and 13.1% (8/61) in level IIB, 22.0% (18/82) in level III, 7.0% (5/71) in level IV, and 6.3% (1/16) in level V. The level V LN was clinically evident preoperatively. Five of 21 (23.8%) elective NDs contained occult LNs, all of which were in level II and without extranodal extension. Twenty-seven (38.6%) patients underwent adjuvant radiation; 19 (27.1%) patients underwent adjuvant chemoradiation. With a mean follow-up of 29 months, 3 patients had developed recurrences, with all but 1 patient still alive. All patients who recurred had refused at least a component of indicated adjuvant treatment. CONCLUSIONS: For p16+OPSCC, therapeutic NDs should encompass any levels bearing suspicious LNs and levels IIA-B, III, and IV, while elective NDs should be performed and encompass at least levels IIA-B and III. These selective ND plans, followed by indicated adjuvant treatment, are associated with a low nodal recurrence rate.
OBJECTIVE: To characterize patterns of neck lymph node (LN) metastases in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma, represented by p16 positivity (p16+OPSCC). STUDY DESIGN: Case series with chart review. SETTING: Tertiary care center. SUBJECTS AND METHODS: Neck dissection (ND) specimens of nonirradiated p16+OPSCC patients were analyzed for frequencies of clinically evident and occult LNs by neck level. Local, regional, and distant recurrences were reviewed. RESULTS: Seventy p16+OPSCC patients underwent primary site transoral robotic surgery and 82 NDs of varying levels. Metastatic pathologic LNs were found at the following frequencies: 0% (0/28) in level I, 75.6% (62/82) in level II with 57.4% (35/61) in level IIA and 13.1% (8/61) in level IIB, 22.0% (18/82) in level III, 7.0% (5/71) in level IV, and 6.3% (1/16) in level V. The level V LN was clinically evident preoperatively. Five of 21 (23.8%) elective NDs contained occult LNs, all of which were in level II and without extranodal extension. Twenty-seven (38.6%) patients underwent adjuvant radiation; 19 (27.1%) patients underwent adjuvant chemoradiation. With a mean follow-up of 29 months, 3 patients had developed recurrences, with all but 1 patient still alive. All patients who recurred had refused at least a component of indicated adjuvant treatment. CONCLUSIONS: For p16+OPSCC, therapeutic NDs should encompass any levels bearing suspicious LNs and levels IIA-B, III, and IV, while elective NDs should be performed and encompass at least levels IIA-B and III. These selective ND plans, followed by indicated adjuvant treatment, are associated with a low nodal recurrence rate.
Authors: Aisling S Last; Patrik Pipkorn; Stephanie Chen; Dorina Kallogjeri; Joseph Zenga; Jason T Rich; Randal Paniello; Jose Zevallos; Rebecca Chernock; Douglas Adkins; Peter Oppelt; Hiram Gay; Mackenzie Daly; Wade Thorstad; Ryan S Jackson Journal: JAMA Otolaryngol Head Neck Surg Date: 2020-01-01 Impact factor: 6.223
Authors: Carlos Miguel Chiesa-Estomba; Juan David Urazan; Cammaroto Giovanni; Mannelli Giuditta; Molteni Gabriele; Dallari Virginia; R Lechien Jerome; Miguel Mayo-Yanez; José Ángel González-García; Jon Alexander Sistiaga-Suarez; Tucciarone Manuel; Ayad Tareck; Meccariello Giuseppe Journal: Eur Arch Otorhinolaryngol Date: 2022-09-14 Impact factor: 3.236