Source: www.docguide.com
Author: Louise Gagnon

The use of a neck dissection is not always necessary in patients with advanced stage oropharyngeal cancer, according to a retrospective study presented here at the 2nd World Congress of the International Academy of Oral Oncology (IAOO).

“Our message is that you don’t have to do a planned neck dissection,” said John Yoo, MD, Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre/University of Western Ontario, London, Ontario.

Chemoradiation is now the standard of care in most centres for patients with advanced oropharyngeal cancer, noted Dr. Yoo.

“You can follow those patients to see if they relapse or have persistent disease,” he explained in an interview on July 10. “You can salvage them if that occurs. The trend is towards not doing a planned neck dissection, but to follow the patients.”

Patients received external beam irradiation in addition to platinum-based chemotherapy. They were staged pathologically and radiologically. They were reassessed at 6 to 8 weeks after treatment for residual disease. Neck dissections were performed only if clinicians had clinical or radiological evidence of residual disease.

Dr. Yoo and colleagues retrospectively analysed 62 patients (49 males, 13 females) treated at the London Regional Cancer Centre between 1999 and 2005. The mean age of patients was 56, and the median follow-up was 32 months. A total of 15 patients were N3 staged, and 47 were N2 stage. Specifically, 18 were stage N2a, another 18 were stage N2b, and 11 were stage N2c.

There was a complete response in 28 of the 47 N2-stage patients and a partial response in the remaining N2-stage patients. Of the 15 N3-stage patients, a complete response was reached in 10 and a partial response in 5.

There was residual disease mass in 4 of the 14 patients with N2-stage that had partial response to therapy and in 2 of the 5 N3-stage patients who had a partial response. Distant metastases were observed in 2 of the 47 N2-stage patients (4%) and in 3 of the 15 N3-stage patients (20%).

Overall survival was 65% for all patients, with N2-stage patients having a rate of 72% and N3-stage patients having a rate of 39%. Overall recurrence-free survival was 90% in N2-stage patients and 76% in N3-stage patients.

The data confirm that it is appropriate to take a step back from aggressive management and not consider doing a planned neck dissection in patients with oropharyngeal cancer with advanced neck disease, according to Dr. Yoo. “It’s a paradigm shift in terms of advanced stage neck cancer,” he said.

The limitation of the study is that it was retrospective, said Dr. Yoo, noting clinicians now would reassess patients at the 12-week mark rather than at 6 to 8 weeks after treatment.

“Most people recommend doing a neck dissection after about 3 months if there is still disease present in the neck,” he noted.

Notes:
1. Presentation title: Oropharyngeal Cancer With Advanced-Stage Regional Metastasis: Outcomes Following Primary Chemoradiation Therapy. Abstract O117. Presented at at the 2nd World Congress of the International Academy of Oral Oncology (IAOO).