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Long-Term Results of the Omission of Postoperative Radiation to the Pathologically Node-Negative Neck in Primary HNSCC

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Key Points

  • At a median follow-up of 53 months, the unirradiated neck control rate was 97%.
  • At 5 years, rates of local control, regional control, progression-free survival, and overall survival were 84%, 93%, 60%, and 64%, respectively.

Long-term results of a single-institution phase II study reported in the Journal of Clinical Oncology by Contreras et al showed that the omission of postoperative radiation therapy to the pathologically negative (PN0) neck was associated with good outcomes among patients with primary head and neck squamous cell carcinoma (HNSCC).

The study involved 72 evaluable patients enrolled between 2007 and 2013 at Washington University Medical School, St. Louis. Patients underwent surgical resection and neck dissection with a PN0 neck and high-risk features mandating postoperative radiation therapy to the primary or involved neck. The primary endpoint was > 90% disease control in the unirradiated neck.

Quality of life was assessed using the MD Anderson Dysphagia Inventory and the University of Michigan patient-reported xerostomia questionnaire. Disease sites included the oral cavity (n = 14), oropharynx (n = 37), hypopharynx (n = 4), larynx (n = 16), and unknown primary tumor (n = 1). Stage III/IV disease was present in 93% of patients, and 71% of tumors involved or crossed the midline. No patient received contralateral neck postoperative radiation therapy.

Disease Control Rates

At a median follow-up of 53 months, two patients experienced treatment failure of the PN0 unirradiated neck, as well as local treatment failure. The unirradiated neck control rate was 97%. At 5 years, rates of local control, regional control, progression-free survival, and overall survival were 84%, 93%, 60%, and 64%, respectively. Quality-of-life measures at 12 and 24 months after postoperative radiation therapy did not differ significantly from baseline (P > .05).

The investigators concluded, “Eliminating postoperative radiation therapy to the PN0 neck resulted in excellent control rates in the unirradiated neck without long-term adverse effects on global quality of life.”

Wade Thorstad, MD, of the Department of Radiation Oncology, Washington University School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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