1. Long term survival in patients with human papillomavirus-positive oropharyngeal cancer and equivocal response on 12-week PET-CT is not compromised by the omission of neck dissection
- Author
-
Suyun, Zhou, Christopher, Chan, Robert, Rulach, Hesham, Dyab, Fraser, Hendry, Carole, Maxfield, Mary-Frances, Dempsey, Allan, James, Derek, Grose, Carolynn, Lamb, Stefano, Schipani, Christina, Wilson, Yee, Cheng Lau, and Claire, Paterson
- Subjects
Cancer Research ,Squamous Cell Carcinoma of Head and Neck ,Papillomavirus Infections ,Chemoradiotherapy ,Alphapapillomavirus ,Oropharyngeal Neoplasms ,Oncology ,Fluorodeoxyglucose F18 ,Head and Neck Neoplasms ,Positron Emission Tomography Computed Tomography ,Carcinoma, Squamous Cell ,Humans ,Neck Dissection ,Neoplasm Recurrence, Local ,Oral Surgery ,Papillomaviridae ,Retrospective Studies - Abstract
The aim of this study was to evaluate the long-term safety of the omission of immediate neck dissections (IND) in patients with human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) achieving a less than complete nodal response on 12-week FDG PET-CT.Patients with HPV-positive, node-positive HNSCC that were treated with radical (chemo) radiotherapy (RT) between January 2013 and September 2019 were identified. PET-CT responses were classified as complete (CR), incomplete (ICR) or equivocal (EQR) nodal responses. Clinical outcomes were obtained.347 patients were identified. Median follow-up was 43.9 (IQR, 30.8-61.2) months. 62.8% (218/347) achieved a CR, 23.4% (81/347) EQR and 13.8% (48/347) ICR nodal response. 70 of 81 (86.4%) patients with an EQR and 25 of 48 (52.1%) with an ICR had no residual disease during follow up (a pathologically negative ND if surgery undertaken or no subsequent neck or distant relapse clinically/radiologically). Median survival of the EQR and CR groups were not reached, and despite the omission of IND in 95% of the EQR group there was no statistically significant differences in overall survival (OS) between the groups, p = 1.0. Median survival of ICR was not reached. However, OS for ICR group was significantly worse than that of CR, and EQR, both p 0.001.The omission of IND in those achieving an EQR nodal response does not compromise long-term survival. This supports the safety of extended surveillance in patients with HPV-positive disease and an EQR on 12-week FDG PET-CT.
- Published
- 2022