Zenga, Joseph

AbstractBackgroundOncologic outcomes of human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (SCC) requiring resection of major muscular or neurovascular tissue during neck dissection for invasive nodal disease remain uncertain.MethodsPatients with HPV‐related oropharyngeal SCC requiring resection of major muscular or neurovascular tissue during their neck dissections were retrospectively identified.ResultsSeventy‐two patients were included. Regional and distant recurrences occurred in 6% and 17% of patients. Advanced T classification, pathological node number of 5 or more, and omission of adjuvant therapy were associated with decreased disease‐free survival (DFS). The addition of adjuvant chemotherapy was not associated with improved survival.ConclusionPatients with invasive nodal disease from HPV‐related oropharyngeal SCC can be managed with up‐front surgery and adjuvant therapy, as indicated with good regional control. Although distant recurrence was the primary site of failure, adjuvant chemotherapy was not associated with improved outcomes. The T classification, node number, and adjuvant radiotherapy are independent prognostic factors in this patient population.

Objectives/HypothesisTo evaluate outcomes for patients with pathological N3 (pN3) neck disease from human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC) and determine variables predictive of survival.Study DesignRetrospective case series with chart review.MethodsThis study was conducted between 1998 and 2013 and included patients with HPV‐related OPSCC treated with surgery with or without adjuvant therapy and who had pN3 nodal disease. The primary outcome was disease‐specific survival (DSS). Secondary outcomes included overall survival (OS), disease‐free survival (DFS), adverse events, and gastrostomy tube rates.ResultsThirty‐nine patients were included, of whom 36 (90%) underwent adjuvant therapy. Median follow‐up was 39 months (range, 2–147 months). Mean age was 56 years, and 87% were male. Seventeen patients (44%) underwent selective neck dissection, whereas six (15%) underwent radical (n = 2) or extended radical (n = 4) neck dissection. Ninety‐two percent had extracapsular extension. Five‐year Kaplan‐Meier estimated DSS, OS, and DFS were 89% (95% confidence interval [CI]: 79%–99%), 87% (95% CI: 75%–99%), and 84% (95% CI: 72%–96%), respectively. The disease recurrence rate was 10% (5% regional, 5% distant metastasis). Patients with less than 5 pathologically positive lymph nodes (P = .041) had improved DFS.ConclusionsPatients with HPV‐related OPSCC and pN3 nodal disease treated with surgery and adjuvant therapy have very favorable long‐term survival and regional control. Patients with five or more pathologically positive lymph nodes may be at higher risk for recurrence.Level of Evidence4. Laryngoscope, 127:2033–2037, 2017

ObjectivesTo 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 DesignMulti‐institutional retrospective review.MethodsTwo 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.ResultsThree 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.ConclusionIn 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 Evidence4. Laryngoscope, 127:623–630, 2017