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Clinical outcomes of patients with oral cavity squamous cell carcinoma and retropharyngeal lymph node metastasis identified by FDG PET/CT.

Tseng JR, Ho TY, Lin CY, Lee LY, Wang HM, Liao CT, Yen TC - PLoS ONE (2013)

Bottom Line: Concomitant contralateral neck lymph node metastases (N2c) were associated with lower 2-year DSS (P = 0.005) and DFS (P = 0.011) rates.OSCC patients with RPLN involvement have poor outcomes.Treatment efforts with curative intent should be tailored according to individual risk factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C. ; Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.

ABSTRACT

Purpose: Retropharyngeal lymph node (RPLN) metastasis is an uncommon finding in patients with oral cavity squamous carcinoma (OSCC). We sought to investigate the clinical outcomes, clinicopathological characteristics, and the priority of treatment with curative intent in OSCC patients with RPLN involvement.

Methods and materials: Between January 2007 and January 2011, we identified 36 patients with primary RPLN metastases (n = 10) or RPLN relapse (n = 26). The follow-up continued until June 2013. Disease-specific survival (DSS), disease-free survival (DFS), and the potential benefits of salvage therapy served as the main outcome measures.

Results: The 2-year DSS and DFS rates of untreated patients with RPLN involvement were 20% and 24%, respectively. Level IV/V neck lymph node involvement was an adverse prognostic factor for DSS (P = 0.048) and DFS (P = 0.018). All of the patients presenting with neck lymph node involvement at level IV/V died within 6 months. Among patients who were treated for RPLN relapse, the 2-year DSS and DFS rates from the relapse day were 12.8% and 9.6%, respectively. Concomitant contralateral neck lymph node metastases (N2c) were associated with lower 2-year DSS (P = 0.005) and DFS (P = 0.011) rates. Moreover, five (55%) of the nine patients with recurrent disease in the contralateral RPLN had distant metastases within 6 months. Salvage therapy yielded the maximum survival benefit in patients without N2c disease and ipsilateral RPLN involvement alone (P = 0.005).

Conclusion: OSCC patients with RPLN involvement have poor outcomes. The risk factor for definitive treatment in OSCC patients with FDG PET/CT defined RPLN disease in primary disease was neck lymph node involvement at level IV/V and N2c and/or contralateral RPLN disease in recurrent disease. Treatment efforts with curative intent should be tailored according to individual risk factors.

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A 35-year-old male patient was diagnosed with right-sided lower gum cancer, stage cT4bN2bN0.The patient underwent curative-intent treatment with concurrent chemo-radiotherapy using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with dose-painting (dose escalation within a gross target volume). The images show the sequential changes in the main tumor (upper panel) as well as in the ipsilateral RPLN (lower panel). The patient had no evidence of recurrence after 51 months of follow-up.
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pone-0079766-g001: A 35-year-old male patient was diagnosed with right-sided lower gum cancer, stage cT4bN2bN0.The patient underwent curative-intent treatment with concurrent chemo-radiotherapy using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with dose-painting (dose escalation within a gross target volume). The images show the sequential changes in the main tumor (upper panel) as well as in the ipsilateral RPLN (lower panel). The patient had no evidence of recurrence after 51 months of follow-up.

Mentions: Ten patients were identified as having RPLN involvement at the initial presentation (Table 2). The 2-year DSS and DFS rates were 20% and 24%, respectively. Seventy percent of patients died within 12 months, and only one patient was alive at 51 months (Fig 1). Survival analysis showed that level IV/V neck lymph node involvement was a marginally significant risk factor for DSS (P = 0.048) and a significant adverse prognostic factor for DFS (P = 0.018) (Fig 2). Three patients with a diagnosis of first primary OSCC and level IV/V neck lymph node involvement died within 6 months, whereas the remaining 7 patients had a median survival time of 10 months (mean, 18.7±18.0 months; range, 4–51 months). During the follow-up period, three patients developed distant metastases (one had bone metastasis at 9 months; one had lung metastasis at 15 months; and the remaining one had bone metastasis at 23 months after the documentation of RPLN involvement).


Clinical outcomes of patients with oral cavity squamous cell carcinoma and retropharyngeal lymph node metastasis identified by FDG PET/CT.

Tseng JR, Ho TY, Lin CY, Lee LY, Wang HM, Liao CT, Yen TC - PLoS ONE (2013)

A 35-year-old male patient was diagnosed with right-sided lower gum cancer, stage cT4bN2bN0.The patient underwent curative-intent treatment with concurrent chemo-radiotherapy using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with dose-painting (dose escalation within a gross target volume). The images show the sequential changes in the main tumor (upper panel) as well as in the ipsilateral RPLN (lower panel). The patient had no evidence of recurrence after 51 months of follow-up.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3823565&req=5

pone-0079766-g001: A 35-year-old male patient was diagnosed with right-sided lower gum cancer, stage cT4bN2bN0.The patient underwent curative-intent treatment with concurrent chemo-radiotherapy using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with dose-painting (dose escalation within a gross target volume). The images show the sequential changes in the main tumor (upper panel) as well as in the ipsilateral RPLN (lower panel). The patient had no evidence of recurrence after 51 months of follow-up.
Mentions: Ten patients were identified as having RPLN involvement at the initial presentation (Table 2). The 2-year DSS and DFS rates were 20% and 24%, respectively. Seventy percent of patients died within 12 months, and only one patient was alive at 51 months (Fig 1). Survival analysis showed that level IV/V neck lymph node involvement was a marginally significant risk factor for DSS (P = 0.048) and a significant adverse prognostic factor for DFS (P = 0.018) (Fig 2). Three patients with a diagnosis of first primary OSCC and level IV/V neck lymph node involvement died within 6 months, whereas the remaining 7 patients had a median survival time of 10 months (mean, 18.7±18.0 months; range, 4–51 months). During the follow-up period, three patients developed distant metastases (one had bone metastasis at 9 months; one had lung metastasis at 15 months; and the remaining one had bone metastasis at 23 months after the documentation of RPLN involvement).

Bottom Line: Concomitant contralateral neck lymph node metastases (N2c) were associated with lower 2-year DSS (P = 0.005) and DFS (P = 0.011) rates.OSCC patients with RPLN involvement have poor outcomes.Treatment efforts with curative intent should be tailored according to individual risk factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C. ; Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.

ABSTRACT

Purpose: Retropharyngeal lymph node (RPLN) metastasis is an uncommon finding in patients with oral cavity squamous carcinoma (OSCC). We sought to investigate the clinical outcomes, clinicopathological characteristics, and the priority of treatment with curative intent in OSCC patients with RPLN involvement.

Methods and materials: Between January 2007 and January 2011, we identified 36 patients with primary RPLN metastases (n = 10) or RPLN relapse (n = 26). The follow-up continued until June 2013. Disease-specific survival (DSS), disease-free survival (DFS), and the potential benefits of salvage therapy served as the main outcome measures.

Results: The 2-year DSS and DFS rates of untreated patients with RPLN involvement were 20% and 24%, respectively. Level IV/V neck lymph node involvement was an adverse prognostic factor for DSS (P = 0.048) and DFS (P = 0.018). All of the patients presenting with neck lymph node involvement at level IV/V died within 6 months. Among patients who were treated for RPLN relapse, the 2-year DSS and DFS rates from the relapse day were 12.8% and 9.6%, respectively. Concomitant contralateral neck lymph node metastases (N2c) were associated with lower 2-year DSS (P = 0.005) and DFS (P = 0.011) rates. Moreover, five (55%) of the nine patients with recurrent disease in the contralateral RPLN had distant metastases within 6 months. Salvage therapy yielded the maximum survival benefit in patients without N2c disease and ipsilateral RPLN involvement alone (P = 0.005).

Conclusion: OSCC patients with RPLN involvement have poor outcomes. The risk factor for definitive treatment in OSCC patients with FDG PET/CT defined RPLN disease in primary disease was neck lymph node involvement at level IV/V and N2c and/or contralateral RPLN disease in recurrent disease. Treatment efforts with curative intent should be tailored according to individual risk factors.

Show MeSH
Related in: MedlinePlus