0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Effect of Postradiotherapy Neck Dissection on Nonregional Disease Sites

Mark C. Ranck, MD1,2; Rainier Abundo, BA2; Gina Jefferson, MD3; Antonia Kolokythas, DDS4; Barry L. Wenig, MD3; Ralph R. Weichselbaum, MD1,2; Michael T. Spiotto, MD, PhD1,2
[+] Author Affiliations
1Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois
2Department of Radiation Oncology, University of Illinois at Chicago Medical Center, Chicago
3Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago Medical Center, Chicago
4Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago Medical Center, Chicago
JAMA Otolaryngol Head Neck Surg. 2014;140(1):12-21. doi:10.1001/jamaoto.2013.5754.
Text Size: A A A
Published online

Importance  After chemoradiation for head and neck cancer, more than 90% of patients who achieve a complete clinical response on imaging have their disease regionally controlled without postradiotherapy neck dissections (PRNDs). Because several groups have reported that lymph node involvement also predicts failure at both the primary and distant sites, the extent to which PRND affects nonregional sites of disease remains unclear.

Objective  To evaluate how PRND affects local control (LC) and distant control in patients who achieve a complete clinical response.

Design, Setting, and Participants  We retrospectively reviewed 287 patients (74 of whom underwent PRND) from the University of Illinois at Chicago Medical Center who were treated for stage III/IV disease with definitive chemoradiation from January 1, 1990, through December 31, 2012.

Interventions  Chemoradiation followed by lymph node dissection or observation.

Main Outcomes and Measures  End points evaluated included LC, regional control, freedom from distant metastasis, progression-free survival (PFS), and overall survival using first-failure analysis.

Results  Patients with advanced nodal disease (stage N2b or greater; n = 176) had improved PFS (74.6% vs 39.1%; P < .001), whereas patients with lesser nodal disease had similar PFS. For patients with advanced nodal disease, PRND improved 2-year LC (85.5% vs 53.5%; P < .001), locoregional control with PRND (78.9% vs 45.7%; P < .001), freedom from distant metastasis (79.5% vs 67.5%; P = .03), and overall survival (84.5% vs 61.7%; P = .004) but not regional control (96.9% vs 90.1%; P = .21). The benefit in LC (87.4% vs 66.2%; P = .02) and PFS (80.7% vs 53.4%; P = .01) persisted for those with negative posttreatment imaging results who underwent PRND. On univariate analysis, PRND, alcohol use, nodal stage, and chemoradiation significantly affected 2-year LC and/or PFS. On multivariate analysis, PRND remained strongly prognostic for 2-year LC (hazard ratio, 0.22; 95% CI, 0.07-0.54; P < .001) and PFS (hazard ratio, 0.42; 95% CI, 0.23-0.74; P = .002).

Conclusions and Relevance  Postradiotherapy neck dissection improved control of nonregional sites of disease in patients with advanced nodal disease who achieved a complete response after chemoradiation. Thus, PRND may affect the control of nonnodal sites through possible mechanisms, such as clearance of incompetent lymphatics and prevention of reseeding of the primary and distant sites.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Outcomes in Patients With Stage III to IV Cancer Undergoing Postradiotherapy Neck Dissection (PRND)

Progression-free survival (PFS) for patients with limited nodal disease (N0-N2a) (2-year PFS: 60.0% vs 68.2%; P = .98) (A) and those with advanced nodal disease (N2b-N3) (2-year PFS: 74.6% vs 39.1%; P < .001) (B). Local control (2-year local control: 85.5% vs 53.5%; P < .001) (C), regional control (2-year regional control: 96.9% vs 90.1%; P = .21) (D), freedom from distant metastases (2-year freedom from distant metastases: 79.5% vs 67.5%; P = .03) (E), and overall survival (2-year overall survival: 84.5% vs 61.7%; P = .004) (F) for those with N2b or greater nodal disease.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Effect of Postradiotherapy Neck Dissection (PRND) on Local Control and Progression-Free Survival in Patients With N2b or Greater Nodal Disease With a Complete Clinical Response on Posttreatment Imaging

Local control (2-year local control: 87.4% vs 66.2%; P = .02) (A), regional control (2-year regional control: 100% vs 93.8%; P = .15) (B), progression-free survival (2-year progression-free survival: 80.7% vs 53.4%; P = .01) (C), and overall survival (2-year overall survival: 88.5% vs 70.8%; P = .18) (D).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Effect of Postradiotherapy Neck Dissection (PRND) on Local Control and/or Progression-Free Survival (PFS) in Distinct Head and Neck Sites

Local control for patients with N2b or greater nodal disease stratified by the hypopharynx (2-year local control: 88.9% vs 50.4%; P = .10) (A), larynx (2-year local control: 76.2% vs 81.3%; P = .33) (B), oral cavity (2-year local control: 80.0% vs 35.6%; P = .01) (C), and oropharynx (2-year local control: 88.5% vs 35.6%; P = .01) (D) sites. Progression-free survival for patients with N2b or greater nodal involvement stratified by the hypopharynx (2-year PFS: 63.6% vs 18.5%; P = .02) (E), larynx (2-year PFS: 88.9% vs 51.3%; P = .03) (F), oral cavity (2-year PFS: 61.5% vs 39.3%; P = .07) (G), and oropharynx (2-year PFS: 85.2% vs 38.5%; P = .001) (H) sites.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();