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Published on: June 14, 2019
Oncologic outcomes of selective neck dissection in HPV-related oropharyngeal squamous cell carcinoma
Joseph Zenga1, Ryan S Jackson1, Evan M Graboyes1
1Department of Otolaryngology-Head and Neck Surgery, Washington University, Saint Louis, Missouri, U.S.A.
Objectives:
To examine outcomes of selective neck dissection (SND) in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) who present with clinical neck disease.
Study Design:
Multi-institutional retrospective review.
Methods:
Two institutional databases of patients with HPV-related OPSCC were reviewed to identify patients with clinical (c) N1-N3 neck disease who underwent SND ± adjuvant therapy.
Results:
Three hundred and twenty-four patients were identified with a median follow-up of 49 months (range 3-199 months). All patients underwent transoral resection of the primary tumor and SND, including levels II-IV and ± levels I or V, with resection of additional nonlymphatic tissue (extended SND) as indicated by extent of disease, including the spinal accessory nerve (7%), the internal jugular vein (13%), and the sternocleidomastoid muscle (8%). Two hundred and seventy (83%) patients underwent adjuvant radiation. There were 13 (4%) regional recurrences and 19 (6%) distant recurrences. Regional control following salvage was 98%. On univariable analysis, absence of radiation was associated with regional recurrence (odds ratio [OR] 9.2, 95% confidence interval [CI] 2.9-29.4). On multivariable analysis, adjuvant radiation was associated with improved disease-free survival (DFS) (OR 0.27, 95% CI 0.14-0.53) but lost significance for overall (OS) and disease-specific survival (DSS) (P > 0.05). Five-year Kaplan-Meier estimates for OS, DSS, and DFS were 88% (95% CI 84%-92%), 93% (95% CI 89%-96%), and 83% (95% CI 78%-87%), respectively.
Conclusion:
In HPV-related OPSCC presenting with clinical neck disease, a SND ± additional tissue resection and adjuvant therapy, when indicated, provides excellent long-term regional control. Omission of radiotherapy increases the risk of regional recurrence, although it may not significantly impact OS or DSS. It appears unnecessary to routinely perform a comprehensive neck dissection.
Level Of Evidence:
4. Laryngoscope, 127:623-630, 2017.
Insights
Selective neck dissection (SND) offers excellent regional control for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) with clinical neck disease. Adjuvant radiation may reduce recurrence risk but doesn't significantly alter overall survival.
Area of Science:
- Oncology
- Head and Neck Surgery
- Human Papillomavirus Research
Background:
- Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is a growing concern.
- Management of clinical neck disease in HPV-related OPSCC requires careful consideration of surgical and adjuvant treatment strategies.
Purpose of the Study:
- To evaluate the outcomes of selective neck dissection (SND) in patients with HPV-related OPSCC presenting with clinical neck disease.
- To assess the impact of adjuvant therapy on regional control and survival in this patient population.
Main Methods:
- Multi-institutional retrospective review of 324 patients with HPV-related OPSCC and clinical (c) N1-N3 neck disease.
- Patients underwent transoral resection and SND (levels II-IV ± I or V), with extended options including resection of adjacent structures.
- Analysis of adjuvant therapy (primarily radiation) and its correlation with recurrence and survival outcomes.
Main Results:
- Excellent long-term regional control was achieved with SND, with only 4% regional recurrence.
- Adjuvant radiation was associated with reduced regional recurrence risk on univariable analysis and improved disease-free survival (DFS) on multivariable analysis.
- Five-year Kaplan-Meier estimates showed high overall survival (88%), disease-specific survival (93%), and DFS (83%).
Conclusions:
- Selective neck dissection, with or without extended resection and indicated adjuvant therapy, provides excellent regional control for HPV-related OPSCC with clinical neck disease.
- Omission of radiotherapy may increase regional recurrence risk but may not significantly impact overall or disease-specific survival.
- Routine comprehensive neck dissection appears unnecessary; tailored SND is effective.
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