Studer Gabriela, Huber Gerhard F, Holz Edna, Glanzmann Christoph
Department of Radiation Oncology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
Eur Arch Otorhinolaryngol. 2016 Jun;273(6):1549-56. doi: 10.1007/s00405-015-3634-5. Epub 2015 Apr 29.
Ongoing debates about the need and extent of planned neck dissection (PND), and required nodal radiation doses volumes lead to this evaluation. Aim was to assess nodal control after definitive intensity modulated radiation therapy (IMRT ± systemic therapy) followed by PND in our head neck cancer cohort with advanced nodal disease. Between 01/2005 and 12/2013, 99 squamous cell cancer HNC patients with pre-therapeutic nodal metastasis ≥3 cm were treated with definitive IMRT followed by PND. In addition, outcome in 103 patients with nodal relapse after IMRT and observation only (no-PND cohort) were analyzed. Prior to PND, PET-CT, fine needle aspirations, ultrasound and palpation were assessed regarding its predictive value. Patterns of nodal relapse were assessed in patients with isolated neck failure after definitive IMRT alone. 70/99 (70 %) PND specimens showed histopathological complete response (hCR), which translated into statistically significantly superior survival compared with partial response (hPR) with 4-year overall survival, disease specific survival and nodal control rates of 90/83/96 vs 67/60/78 % (p = 0.002/0.001/0.003). 1/99 patient developed isolated subsequent nodal disease. 64/2147 removed nodes contained viable tumor (3 %). Predictive information of the performed diagnostic investigations was not reliable. 17/70 hCR patients showed true negative findings in available three to four investigations (0/29 hPR). 27/103 no-PND patients developed isolated neck disease (26 %) with successful salvage in 21/24 [88 %, or 21/27 (78 %)]. Nearly all failures occurred in the prior nodal gross tumor volume area. A more restrictive approach regarding PND and/or nodal IMRT dose-volumes may be justified.
关于计划性颈清扫术（PND）的必要性和范围以及所需的淋巴结放疗剂量体积的持续争论引发了这项评估。目的是评估在我们患有晚期淋巴结疾病的头颈癌队列中，确定性调强放疗（IMRT±全身治疗）后行PND的淋巴结控制情况。在2005年1月至2013年12月期间，99例治疗前淋巴结转移≥3 cm的鳞状细胞癌头颈癌患者接受了确定性IMRT，随后行PND。此外，分析了103例IMRT后仅观察（无PND队列）出现淋巴结复发患者的结局。在PND之前，评估了PET-CT、细针穿刺、超声和触诊的预测价值。对仅接受确定性IMRT后出现孤立性颈部失败的患者的淋巴结复发模式进行了评估。70/99（70%）的PND标本显示组织病理学完全缓解（hCR），与部分缓解（hPR）相比，其生存具有统计学上的显著优势，4年总生存率、疾病特异性生存率和淋巴结控制率分别为90/83/96%和67/60/78%（p = 0.002/0.001/0.003）。1/99例患者出现孤立性后续淋巴结疾病。2147个切除的淋巴结中有64个含有存活肿瘤（3%）。所进行的诊断检查的预测信息不可靠。17/70例hCR患者在可用的三到四项检查中显示真阴性结果（0/29例hPR）。27/103例无PND患者出现孤立性颈部疾病（26%），21/24例（88%，或21/27例（78%））成功挽救。几乎所有失败都发生在先前淋巴结大体肿瘤体积区域。对于PND和/或淋巴结IMRT剂量体积采用更严格的方法可能是合理的。
