Control of nodal metastases in patients with squamous cell head and neck cancer treated with non-surgical modalities

The status of the neck nodes is a major determinant of outcome in patients with squamous cell head and neck cancer. In case of regional recurrence after primary radiation, salvage surgery is often possible, but is associated with additional morbidity and worse prognosis. Therefore, in patients with advanced nodal stages, sometimes a planned neck dissection is performed after primary treatment with radiotherapy or chemoradiotherapy. However, in only approximately 30% of these patients, residual nodal tumor mass is found.

Therefore, identification of patients with regional metastases who are at risk for regional failure after curative non-surgical treatment could possibly reduce the number of patients undergoing unnecessary surgical procedures. The purpose of our study was to evaluate the prognostic significance of a number of CT-based pre-treatment nodal and treatment-related characteristics with regard to regional control.  

The analysis was done on patient level (regional control) and node level (nodal control).

We found that nodal volume and the use of chemotherapy are the most important prognostic factors to control pathological nodes in the neck (regional control). Radiological central necrosis and extranodal growth, nodal volume and chemotherapy were significant prognostic factors for nodal control. Additionally, it appeared that regional control in subjects treated with primary radiation alone, or with chemoradiation in case of a total nodal volume of more than 3.0 cm, resulted in an unacceptable high risk on regional recurrence.

Bibliographical reference:

Vergeer MR et al.: "Control of nodal metastases in squamous cell head and neck cancer treated by radiation therapy or chemoradiation", Radiother Oncol. 2006 Apr;79(1):39-44

Marije R. Vergeer

Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands