Eliminating Postoperative Radiation to the Pathologically Node-Negative Neck: Long-Term Results of a Prospective Phase II Study

Author:

Contreras Jessika A.1,Spencer Christopher1,DeWees Todd2,Haughey Bruce34,Henke Lauren E.1,Chin Re-I1,Paniello Randal1,Rich Jason1,Jackson Ryan1,Oppelt Peter1,Pipkorn Patrik1,Zevallos Jose1,Chernock Rebecca1,Nussenbaum Brian5,Daly Mackenzie1,Gay Hiram1,Adkins Douglas1,Thorstad Wade1

Affiliation:

1. Washington University, St Louis, MO

2. Mayo Clinic, Phoenix, AZ

3. Advent Health Celebration, Celebration; Morsani College of Medicine, Tampa, FL

4. University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand

5. American Board of Otolaryngology-Head and Neck Surgery, Houston, TX

Abstract

PURPOSE The volume treated with postoperative radiation therapy (PORT) is a mediator of toxicity, and reduced volumes result in improved quality of life (QOL). In this phase II trial, treatment volumes were reduced by omitting PORT to the pathologically negative (PN0) neck in patients with primary head and neck squamous cell carcinoma. METHODS Patients with head and neck squamous cell carcinoma who underwent surgical resection and neck dissection with a PN0 neck and high-risk features mandating PORT to the primary and/or involved neck were eligible. The primary end point was greater than 90% disease control in the unirradiated neck. QOL was evaluated using the MD Anderson Dysphagia Inventory and the University of Michigan patient-reported xerostomia questionnaire. RESULTS Seventy-three patients were enrolled, and 72 were evaluable. Median age was 56 years (range, 31 to 81 years); 58 patients were male, and 47 (65%) had a smoking history. Sites included oral cavity (n = 14), oropharynx (n = 37), hypopharynx (n = 4), larynx (n = 16), and unknown primary tumor (n = 1). According to the American Joint Committee on Cancer Staging Manual (7th edition), 67 patients (93%) had stage III/IV disease, and 71% of tumors involved or crossed midline. No patient had contralateral neck PORT. In 17 patients (24%), only the primary site was treated. At a median follow-up of 53 months, two patients experienced treatment failure of the PN0 unirradiated neck; they also experienced treatment failure locally. Unirradiated neck control was 97% (95% CI, 93.4% to 100.0%). Five-year rates of local control, regional control, progression-free survival, and overall survival were 84%, 93%, 60%, and 64%, respectively. QOL measures were not significantly different from baseline at 12 and 24 months post-PORT ( P > .05). CONCLUSION Eliminating PORT to the PN0 neck resulted in excellent control rates in the unirradiated neck without long-term adverse effects on global QOL.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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