Neck lymph node status on survival of regionally recurrent or persistent nasopharyngeal carcinoma (original) (raw)
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The role of elective neck dissection during surgical salvage for recurrent nasopharyngeal carcinoma
Journal of Nasopharyngeal Carcinoma, 2014
Background: To study the incidence of microscopic tumour deposit in the neck in patients with recurrent nasopharyngeal carcinoma (NPC) and hence, the role of routine elective neck dissection during nasopharyngectomy. Methods: Retrospective review of the pathology report of the selective neck dissection specimens in patients with recurrent NPC and clinically N0 status. Results: Between 2000 and 2012, 38 patients presented with recurrent NPC requiring maxillary swing nasopharyngectomy and free flap reconstruction. The initial T-classification of the tumour was T1, 15.8%; T2, 52.6%; and T3, 31.6%, and the N-classification was N0, 26.3%; N1, 47.4%, N2, 15.8%; and N3, 10.5%. Concurrent chemoradiation was given in 57.9% of the subjects. All patients in the series had complete response after the initial treatment, and the mean time to develop local tumour recurrence was 22.3 months. Among these patients, only 1 (2.6%) demonstrated microscopic tumour metastasis in 1 lymph node removed during selective neck dissection. Conclusions:Given the low incidence of microscopic tumour metastasis in patients with recurrent NPC and clinically N0 status, routine elective neck dissection may not be indicated. Further large scale investigation is indicated to address the issue.
Local and Lymph Node Relapse of Nasopharyngeal Carcinoma: A Single-Center Experience
Ear, Nose & Throat Journal, 2020
Objectives: The study aimed to investigate the epidemiological and clinical characteristics as well as the therapeutic results in patients with locoregional (LR) relapse after treatment of nasopharyngeal carcinoma (NPC). Methods: We retrospectively reviewed the medical records of patients with local and/or regional recurrent NPC over 13 years (2003-2015). Results: Twenty-five patients were treated for local or/and local–regional recurrence of NPC. The rate of LR relapse was 7.2%. The mean age of the patients was 46 ± 13.9 years. The median time to relapse was 25 months. The recurrence was nasopharyngeal in 17 patients, nasopharyngeal and neck lymph nodes in 7 patients, and neck lymph nodes in 1 patient. Fifteen relapsed patients had a locally advanced disease (rT3-rT4). Patients who had initially T1 or T2 tumor had a locally advanced relapsed disease (rT3rT4) in 27.3% and patients whose disease was initially classified as T3 or T4 had a locally advanced relapsed disease (rT3T4) in 8...
Head & Neck, 2012
Background. Neck dissection has been shown to be effective in controlling nodal failures in nasopharyngeal carcinoma. Its efficacy in controlling the disease in patients with synchronous locoregional failure is, however, not documented. Method. A retrospective review of all patients who underwent neck dissection for nodal failures with or without treated local failure within 6 months was conducted for this study. The survivals of these 2 groups of patients were analyzed. Results. The 5-year overall survival of the whole cohort was 58%. There was no difference in 5-year disease specific survival (68% vs 40%; p ¼ .121) and 5-year progression free survival (44% vs 36%; p ¼ .334) when comparing patients with isolated nodal failures and synchronous locoregional failures. Multivariate analysis showed that only the initial N classification affects survival. Conclusion. Neck dissection is efficacious in patients with nasopharyngeal carcinoma with nodal failure, with or without synchronous local failures. V
The Laryngoscope, 2018
To compare survival effects of comprehensive neck dissection (CND) and selective neck dissection (SND) for patients with nasopharyngeal carcinoma (NPC) with only regional failure. A total of 294 recurrent T0N1-3M0 NPC patients who underwent neck dissection in Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China, between January 1984 and February 2014, were enrolled in the survival and interaction analyses. Using propensity scores to adjust for potential prognostic factors, an additional well-balanced cohort of 210 patients was constructed by matching each patient who received SND with one patient who underwent CND (1:1); the differences were then compared between SND and CND in terms of overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS). Both univariate and multivariate analyses showed that SND was not inferior to CND (P > 0.05) but demonstrated that extraca...
Radical Neck Dissection in Nasopharyngeal Carcinoma
ANZ Journal of Surgery, 1991
We report a series of 37 patients who had radical neck dissection for residual or recurrent lymph node metastasis from nasopharyngeal carcinoma after radiotherapy. The operation was performed despite high doses of pre-operative radiotherapy. There was no operative mortality and the morbidity was 13% (2 prolonged chylous drainage, 3 sloughing of neck flap). The risk of sloughing of neck flap was significantly related to previous lymph node biopsy, which should be avoided if at all possible. In 35% of patients, the lymph node was densely adherent to neighbouring structures. In the 28 patients who had single lymph node clinically, 29% had multiple neck node involvement noted during operation; another 14% were. documented only on histological examination. Radical neck dissection rather than excision alone is justified for the clinically solitary lymph node.
Benha Medical Journal, 2022
Background: Identification of occult nodal metastasis is an important determinant for staging and prognosis, particularly for adjuvant treatment modalities in head and neck cancer. Objectives: to analyze the lymph node yield after elective (selective neck dissection level II-IV) for advanced glottic carcinoma with clinically negative neck and correlate this with early post-surgical outcomes. Patient and methods: This is a case series study conducted on thirty (30) consecutive candidates for total laryngectomy at Otolaryngology departments of both Benha and Tanta University hospitals. Elective bilateral selective neck dissection SND (II-IV) was done in 18 patients (60%).Unilateral SND (II-IV) was done 12 patients (40%). Results: The mean for level II was 9.1, for level III: 11.5 and for level IV: 6.2. The mean nodal yield of SND (II-IV) is 47.7 LNs (range 12-99). There is high significance association between lymph node yield and age (p value=0.001) and with the need of postoperative radiotherapy (p value =0.031). Intraoperative complication; internal jugular vein injured in one case (3.33%). There is significant association between postoperative complications and patient's age (p value = 0.032), preoperative tracheostomy (p value =0.002), side of neck dissection (p value =0.004), positive lymph nodes in level II dissection (p value =0.005) and overall total size of the tumor (p value =0.033) when overall total tumor size exceeds 20 cm 3. Conclusion: Lymph node yield and ratio directly influence the prognosis and postoperative outcomes and could be considered in staging of those patients.
Cancer, 2016
Prospective quality metrics for neck dissection have not been established for patients with head and neck squamous cell carcinoma. The purpose of this study was to investigate the association between lymph node counts from neck dissection, local-regional recurrence, and overall survival. The number of lymph nodes counted from neck dissection in patients treated in 2 NRG Oncology trials (Radiation Therapy Oncology Group [RTOG] 9501 and RTOG 0234) was evaluated for its prognostic impact on overall survival with a multivariate Cox model adjusted for demographic, tumor, and lymph node data and stratified by the postoperative treatment group. Five hundred seventy-two patients were analyzed at a median follow-up of 8 years. Ninety-eight percent of the patients were pathologically N+. The median numbers of lymph nodes recorded on the left and right sides were 24 and 25, respectively. The identification of fewer than 18 nodes was associated with worse overall survival in comparison with 18 ...
Journal of Clinical Oncology, 2015
BACKGROUND: Prospective quality metrics for neck dissection have not been established for patients with head and neck squamous cell carcinoma. The purpose of this study was to investigate the association between lymph node counts from neck dissection, local-regional recurrence, and overall survival. METHODS: The number of lymph nodes counted from neck dissection in patients treated in 2 NRG Oncology trials (Radiation Therapy Oncology Group [RTOG] 9501 and RTOG 0234) was evaluated for its prognostic impact on overall survival with a multivariate Cox model adjusted for demographic, tumor, and lymph node data and stratified by the postoperative treatment group. RESULTS: Five hundred seventy-two patients were analyzed at a median follow-up of 8 years. Ninety-eight percent of the patients were pathologically N1. The median numbers of lymph nodes recorded on the left and right sides were 24 and 25, respectively. The identification of fewer than 18 nodes was associated with worse overall survival in comparison with 18 or more nodes (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.09-1.74; P 5.007). The difference appeared to be driven by local-regional failure (HR, 1.46; 95% CI, 1.02-2.08; P 5.04) but not by distant metastases (HR, 1.08; 95% CI, 0.77-1.53; P 5.65). When the analysis was limited to NRG Oncology RTOG 0234 patients, adding the p16 status to the model did not affect the HR for dissected nodes, and the effect of nodes did not differ with the p16 status. CONCLUSIONS: The removal and identification of 18 or more lymph nodes was associated with improved overall survival and lower rates of local-regional failure, and this should be further evaluated as a measure of quality in neck dissections for mucosal squamous cell carcinoma. Cancer 2016;000:000-000.
Pretreatment neck node biopsy, distant metastases, and survival in nasopharyngeal carcinom
Head & …, 1993
Pretreatment neck node biopsy had been performed on 50 of 422 patients who had cervical node metastases from nasopharyngeal carcinoma when initially seen. Multivariate analysis using the Cox proportional hazards model shows that pretreatment node biopsy is not a significant determinant of distant metastases, survival, or recurrence in the neck. Results of similar studies are reviewed and the role of pretreatment node biopsy in nasopharyngeal carcinoma discussed.