Long term survival in patients with human papillomavirus-positive oropharyngeal cancer and equivocal response on 12-week PET-CT is not compromised by the omission of neck dissection

Zhou, S. et al. (2022) Long term survival in patients with human papillomavirus-positive oropharyngeal cancer and equivocal response on 12-week PET-CT is not compromised by the omission of neck dissection. Oral Oncology, 128, 105870. (doi: 10.1016/j.oraloncology.2022.105870) (PMID:35447564)

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Abstract

The aim of this study was to evaluate the long-term safety of the omission of immediate neck dissections (IND) in patients with human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) achieving a less than complete nodal response on 12-week FDG PET-CT. Patients with HPV-positive, node-positive HNSCC that were treated with radical (chemo) radiotherapy (RT) between January 2013 and September 2019 were identified. PET-CT responses were classified as complete (CR), incomplete (ICR) or equivocal (EQR) nodal responses. Clinical outcomes were obtained. 347 patients were identified. Median follow-up was 43.9 (IQR, 30.8-61.2) months. 62.8% (218/347) achieved a CR, 23.4% (81/347) EQR and 13.8% (48/347) ICR nodal response. 70 of 81 (86.4%) patients with an EQR and 25 of 48 (52.1%) with an ICR had no residual disease during follow up (a pathologically negative ND if surgery undertaken or no subsequent neck or distant relapse clinically/radiologically). Median survival of the EQR and CR groups were not reached, and despite the omission of IND in 95% of the EQR group there was no statistically significant differences in overall survival (OS) between the groups, p = 1.0. Median survival of ICR was not reached. However, OS for ICR group was significantly worse than that of CR, and EQR, both p < 0.001. The omission of IND in those achieving an EQR nodal response does not compromise long-term survival. This supports the safety of extended surveillance in patients with HPV-positive disease and an EQR on 12-week FDG PET-CT.

Item Type:Articles
Keywords:Humans, carcinoma, squamous Cell - diagnostic imaging - surgery, overall survival, neck dissection, papillomaviridae, chemotherapy, neck dissection, radiotherapy, head and neck cancer, human papillomavirus, PET/CT, retrospective studies, response assessment, survival outcomes, oropharyngeal cancer, chemoradiotherapy, neoplasm recurrence, local, oropharyngeal neoplasms - diagnostic imaging - pathology - surgery, fluorodeoxyglucose F18, papillomavirus infections - complications, alphapapillomavirus, squamous cell carcinoma of head and neck - diagnostic imaging - surgery, head and neck neoplasms, positron emission tomography computed tomography.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Schipani, Dr Stefano and Paterson, Dr Claire and Grose, Dr Derek and Rulach, Dr Robert
Authors: Zhou, S., Chan, C., Rulach, R., Dyab, H., Hendry, F., Maxfield, C., Dempsey, M.-F., James, A., Grose, D., Lamb, C., Schipani, S., Wilson, C., Cheng Lau, Y., and Paterson, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
Journal Name:Oral Oncology
Publisher:Elsevier
ISSN:1368-8375
ISSN (Online):1879-0593
Published Online:18 April 2022

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