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Eliminating radiotherapy to the contralateral retropharyngeal and high level II lymph nodes in head and neck squamous cell carcinoma is safe and improves quality of life
Author(s) -
Spencer Christopher R.,
Gay Hiram A.,
Haughey Bruce H.,
Nussenbaum Brian,
Adkins Douglas R.,
Wildes Tanya M.,
DeWees Todd A.,
Lewis James S.,
Thorstad Wade L.
Publication year - 2014
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28938
Subject(s) - medicine , head and neck squamous cell carcinoma , radiation therapy , quality of life (healthcare) , cervical lymph nodes , dysphagia , confidence interval , head and neck cancer , lymph , radiology , prospective cohort study , surgery , oncology , cancer , metastasis , pathology , nursing
BACKGROUND Radiation treatment volumes in head and neck squamous cell carcinoma (HNSCC) are controversial. The authors report the outcomes, patterns of failure, and quality of life (QOL) of patients who received treatment for HNSCC using intensity‐modulated radiation therapy (IMRT) that eliminated the treatment of contralateral retropharyngeal lymph nodes (RPLNs) in the clinically uninvolved neck. METHODS A prospective institutional database was used to identify patients who had primary oral cavity, oropharyngeal, hypopharyngeal, laryngeal, and unknown primary HNSCC for which they received IMRT. There were 3 temporal groups (generations 1‐3). Generation 1 received comprehensive neck IMRT with parotid sparing, generation 2 eliminated the contralateral high level II (HLII) lymph nodes, and generation 3 further eliminated the contralateral RPLNs in the clinically uninvolved neck. Patterns of failure and survival analyses were completed, and QOL data measured using the MD Anderson Dysphagia Inventory were compared in a subset of patients from generations 1 and 3. RESULTS In total, 748 patients were identified. Of the 488 patients who received treatment in generation 2 or 3, 406 had a clinically uninvolved contralateral neck. There were no failures in the spared RPLNs (95% confidence interval, 0%‐1.3%) or in the high contralateral neck (95% confidence interval, 0%‐0.7%). QOL data were compared between 44 patients in generation 1 and 51 patients in generation 3. QOL improved both globally and in all domains assessed for generation 3, in which reduced radiotherapy volumes were used ( P < .007). CONCLUSIONS For patients with locally advanced HNSCC, eliminating coverage to the contralateral HLII lymph nodes and contralateral RPLNs in the clinically uninvolved side of the neck is associated with minimal risk of failure in these regions and significantly improved patient‐reported QOL. Cancer 2014;120:3994–4002. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society .