Carole Pflumio1, Idriss Troussier2, Xu Shan Sun3, Julia Salleron4, Claire Petit5, Matthieu Caubet6, Arnaud Beddok7, Valentin Calugaru7, Stéphanie Servagi-Vernat8, Joël Castelli9, Jessica Miroir10, Marco Krengli11, Paul Giraud12, Edouard Romano12, Jonathan Khalifa13, Mélanie Doré14, Nicolas Blanchard15, Alexandre Coutte16, Charles Dupin17, Shakeel Sumodhee17, Yoann Pointreau18, Samir Patel19, Amel Rehailia-Blanchard20, Ludivine Catteau21, René-Jean Bensadoun22, Yungan Tao5, Vincent Roth23, Lionnel Geoffrois1, Jean-Christophe Faivre24, Juliette Thariat25. 1. Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France. 2. Department of Radiation Therapy, CHU Pitié Salpêtrière, Assistance Publique, Hôpitaux de Paris, Paris, France. 3. Department of Radiation Therapy, Hôpital de Montbéliard, Montbéliard, France. 4. Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France. 5. Department of Radiation Therapy, Institut Gustave Roussy, Villejuif, France. 6. Department of Radiation Therapy, CHU de Besançon, Besançon, France. 7. Department of Radiation Therapy, Institut Curie, Paris, France. 8. Department of Radiation Therapy, Institut Jean Godinot, Reims, France. 9. Department of Radiation Therapy, Institut Eugène Marquis, Rennes, France. 10. Department of Radiation Therapy, Institut Jean Perrin, Clermont-Ferrand, France. 11. Department of Radiation Therapy, University of Piemonte Orientale, Pavia, Italy. 12. Department of Radiation Therapy, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Paris, France. 13. Department of Radiation Therapy, Institut Universitaire du Cancer, Toulouse, France. 14. Department of Radiation Therapy, Institut de Cancérologie de l'Ouest, Nantes, France. 15. Department of Radiation Therapy, Clinique les Dentellières, Valenciennes, France. 16. Department of Radiation Therapy, CHU d'Amiens, Amiens, France. 17. Department of Radiation Therapy, Centre Antoine Lacassagne, Nice, France. 18. Department of Radiation Therapy, Clinique Victor Hugo, Le Mans, France. 19. Department of Radiation Therapy, Mayo Clinic, Arizona, USA. 20. Department of Radiation Therapy, CHU de Saint-Étienne, Saint-Étienne, France. 21. Department of Radiation Therapy, CHU de Poitiers, Poitiers, France. 22. Department of Radiation Therapy, Centre de Haute Énergie, Nice, France. 23. Easy CRF. 8 rue Lecourtois, Mathieu, France. 24. Academic Department of Radiation Therapy, Lorraine Institute of Cancerology, Vandoeuvre-lès-Nancy, France. 25. Department of Radiation Therapy, Centre Francois Baclesse, Advanced Resource Center for Hadrontherapy in Europe, Caen, France, Unicaen-Normandie Universite. Electronic address: jthariat@gmail.com.
Abstract
INTRODUCTION: Patients with cervical lymphadenopathy of unknown primary carcinoma (CUP) usually undergo neck dissection and irradiation. There is an ongoing controversy regarding the extent of nodal and mucosal volumes to be irradiated. We assessed outcomes after bilateral or unilateral nodal irradiation. METHODS: This retrospective multicentre study included patients with CUP and squamous cellular carcinoma who underwent radiotherapy (RT) between 2000 and 2015. RESULTS: Of 350 patients, 74.5% had unilateral disease and 25.5% had bilateral disease. Of 297 patients with available data on disease and irradiation sides, 61 (20.5%) patients had unilateral disease and unilateral irradiation, 155 (52.2%), unilateral disease and bilateral irradiation and 81 (27.3%), bilateral disease and bilateral irradiation. Thirty-four (9.7%) and 217 (62.0%) patients received neoadjuvant and/or concomitant chemotherapy, respectively. Median follow-up was 37 months. Three-year local, regional, locoregional failure rates and CUP-specific survival were 5.6%, 11.7%, 15.0% and 84.7%, respectively. In patients with unilateral disease, the 3-year cumulative incidence of regional/local relapse was 7.7%/4.3% after bilateral irradiation versus 16.9%/11.1% after unilateral irradiation (hazard ratio = 0.56/0.61, p = 0.17/0.32). The cumulative incidence of CUP-specific deaths was 9.2% after bilateral irradiation and 15.5% after unilateral irradiation (p = 0.92). In multivariate analysis, mucosal irradiation was associated with better local control, whereas no neck dissection, ≥N2b and interruption of RT for more than 4 days were associated with poorer regional control. Toxicity was higher after bilateral irradiation (p < 0.05). No positron-emission tomography-computed tomography, largest node diameter, ≥N2b, neoadjuvant chemotherapy and interruption of RT were associated with poorer cause-specific survival. CONCLUSION: Bilateral nodal irradiation yielded non-significant better nodal and mucosal control rates but was associated with higher rates of severe toxicity.
INTRODUCTION:Patients with cervical lymphadenopathy of unknown primary carcinoma (CUP) usually undergo neck dissection and irradiation. There is an ongoing controversy regarding the extent of nodal and mucosal volumes to be irradiated. We assessed outcomes after bilateral or unilateral nodal irradiation. METHODS: This retrospective multicentre study included patients with CUP and squamous cellular carcinoma who underwent radiotherapy (RT) between 2000 and 2015. RESULTS: Of 350 patients, 74.5% had unilateral disease and 25.5% had bilateral disease. Of 297 patients with available data on disease and irradiation sides, 61 (20.5%) patients had unilateral disease and unilateral irradiation, 155 (52.2%), unilateral disease and bilateral irradiation and 81 (27.3%), bilateral disease and bilateral irradiation. Thirty-four (9.7%) and 217 (62.0%) patients received neoadjuvant and/or concomitant chemotherapy, respectively. Median follow-up was 37 months. Three-year local, regional, locoregional failure rates and CUP-specific survival were 5.6%, 11.7%, 15.0% and 84.7%, respectively. In patients with unilateral disease, the 3-year cumulative incidence of regional/local relapse was 7.7%/4.3% after bilateral irradiation versus 16.9%/11.1% after unilateral irradiation (hazard ratio = 0.56/0.61, p = 0.17/0.32). The cumulative incidence of CUP-specific deaths was 9.2% after bilateral irradiation and 15.5% after unilateral irradiation (p = 0.92). In multivariate analysis, mucosal irradiation was associated with better local control, whereas no neck dissection, ≥N2b and interruption of RT for more than 4 days were associated with poorer regional control. Toxicity was higher after bilateral irradiation (p < 0.05). No positron-emission tomography-computed tomography, largest node diameter, ≥N2b, neoadjuvant chemotherapy and interruption of RT were associated with poorer cause-specific survival. CONCLUSION: Bilateral nodal irradiation yielded non-significant better nodal and mucosal control rates but was associated with higher rates of severe toxicity.
Authors: Olgun Elicin; Paul Martin Putora; Marco Siano; Martina A Broglie; Christian Simon; Daniel Zwahlen; Gerhard F Huber; Giorgio Ballerini; Lorenza Beffa; Roland Giger; Sacha Rothschild; Sandro V Negri; Pavel Dulguerov; Guido Henke Journal: Front Oncol Date: 2019-10-24 Impact factor: 6.244
Authors: Francisco J Civantos; Jan B Vermorken; Jatin P Shah; Alessandra Rinaldo; Carlos Suárez; Luiz P Kowalski; Juan P Rodrigo; Kerry Olsen; Primoz Strojan; Antti A Mäkitie; Robert P Takes; Remco de Bree; June Corry; Vinidh Paleri; Ashok R Shaha; Dana M Hartl; William Mendenhall; Cesare Piazza; Michael Hinni; K Thomas Robbins; Ng Wai Tong; Alvaro Sanabria; Andres Coca-Pelaz; Johannes A Langendijk; Juan Hernandez-Prera; Alfio Ferlito Journal: Front Oncol Date: 2020-11-10 Impact factor: 6.244