Neck dissection after chemoradiotherapy for oropharyngeal and hypopharyngeal cancer: the correlation between cervical lymph node metastasis and prognosis

详细信息    查看全文

• 作者：Nobuhiro Hanai (1)
  Daisuke Kawakita (2)
  Taijiro Ozawa (1)
  Hitoshi Hirakawa (1)
  Takeshi Kodaira (3)
  Yasuhisa Hasegawa (1)
  
• 关键词：Chemoradiotherapy ; Neck dissection ; Squamous cell carcinoma ; Cervical lymph node metastasis
• 刊名：International Journal of Clinical Oncology
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：19
• 期：1
• 页码：30-37
• 全文大小：325 KB
• 作者单位：Nobuhiro Hanai (1)
  Daisuke Kawakita (2)
  Taijiro Ozawa (1)
  Hitoshi Hirakawa (1)
  Takeshi Kodaira (3)
  Yasuhisa Hasegawa (1)
  
  1. Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
  2. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
  3. Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
  
• ISSN：1437-7772

文摘

Background Recently, the role of chemoradiotherapy (CRT) for preserving organs in the treatment of head and neck cancer has been increasing. However, the indication for post-CRT neck dissection (ND) and its surgical extent is still controversial. The purpose of this study was to discuss the indications for post-CRT ND and the proper extent of the surgical procedure. Methods We performed a retrospective analysis on N2- oropharyngeal and hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with CRT in our institute from 1995 to 2008, and determined the prognostic impact of post-CRT ND and the distribution of cervical lymph node (CLN) metastasis based on the pathological results of ND. Results The patients without pathological CLN metastases had good prognoses, whereas patients with pathological CLN metastases exhibited a significantly high recurrence rate (P?=?0.033). Based on the pathological results of ND, performing selective ND at levels II–IV can contain 88 and 85?% of CLN metastasis of the oropharynx and hypopharynx, respectively. In all cases, when pathological CLN metastases were found at level V in ND following CRT, distant metastases developed. Conclusions The presence of pathological CLN metastasis affects prognosis, but also a diffuse distribution of CLN metastasis worsens prognosis; that is, the presence of CLN metastasis at level V after CRT?appears to be an indicator of distant metastasis. Post-CRT ND may not make sense as a salvage intervention for improving the prognosis in such situations. We concluded that the proper extent of post-CRT ND of OHSCC is selective ND including levels II–IV.