Federico Laurel Ampil MD, Presenter: Nothing to Disclose

Gloria Caldito PhD, Abstract Co-Author: Nothing to Disclose

Cherie-Ann Nathan MD, Abstract Co-Author: Nothing to Disclose

Ghali Ghali MD, DDS, Abstract Co-Author: Nothing to Disclose

Roxana Baluna MD, PhD, Abstract Co-Author: Nothing to Disclose

The nodal status is an established prognostic factor in head and neck cancer (HNC), and there seems to be a greater risk of regional recurrence in patients as the number of cervical lymph nodes with metastatic tumor increases.  Because of the controversial role of adjuvant postoperative radiotherapy (APR) in people with HNC and limited nodal disease, our goal was to review the university’s experience of APR in such patients with a single metastasis-positive cervical node, and as a secondary objective, we attempt to determine the circumstances in which APR may be indicated in this particular cohort.

Between 1976 and 2000, 37 individuals were identified as the subjects of this Louisiana State University Health Sciences Center Institutional Review Board-approved clinical investigation. Patients were eligible for the study if they had confirmed HNC; had undergone definitive surgery which included neck dissection; exhibited histopathologic documentation of the presence of metastatic tumor in a single cervical lymph node; and did not have known systemic spread of the disease.  Exclusion criteria were the presence of metastatic neoplasm in two or more cervical lymph nodes and extracapsular nodal tumor extension.

Among the 35 evaluable patients, the observed failure rates at the primary site, neck and distant location were 11%, 15% and 6% respectively. The overall 5-year relapse-free survival rate was 60%. The relapse-free survival rate at 5 years was 86% in nine individuals who did not have additional histopathological risk factors and 55% in those people who did (p=.46); the corresponding locoregional relapse rates were 13% and 26% respectively (p=.65).

The relapse risk is low and prognosis satisfactory in postoperatively irradiated HNC patients with single metastasis-positive cervical lymph node. More research is needed to determine who among this group will and will not benefit from the administration of APR.

Further study is required to provide a clearer treatment recommendation for head and neck cancer patients with a single histologically positive cervical lymph node.

Ampil, F, Caldito, G, Nathan, C, Ghali, G, Baluna, R, Postoperative Radiotherapy for Head and Neck Cancer with Single Positive Node.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8000025.html