Effectiveness of postoperative radiotherapy in patients with small oral and oropharyngeal squamous cell carcinoma and concomitant ipsilateral singular cervical lymph node metastasis (pN1)

A meta-analysis
  • Maximilian Moergel
  • Philipp Meurer
  • Katharina Ingel
  • Thomas G. Wendt
  • Bilal Al-Nawas
Current Discussion

Background:

The positive effect of radiation therapy for patients with advanced oropharyngeal squamous cell carcinoma (OSCC) has been substantially verified. The present work investigated whether a meta-analysis of current data is able to evaluate the effectiveness of postoperative radiotherapy (PORT) in patients with small OSCC (pT1, pT2) and a single ipsilateral lymph node metastasis (pN1).

Methods:

The meta-analysis comprises randomized and non-randomized studies. High-risk tumors were excluded and defined by size ≥ pT3/pT4, lymph node involvement ≥ pN2, or presence of additional histological risk factors, e.g., involved positive resection margins, extra nodal spread of the disease, or lymphangiosis carcinomatosa. The primary outcome analyzed mortality between the different treatment arms.

Results:

Only one prospective randomized clinical trial and six retrospective observational studies were adequate for evaluation. Descriptive analysis revealed a marginally higher mortality in the irradiation group (44% vs. 34%). In contrast, a forest plot presentation of two of seven studies with and without events in the control and therapy arms presented an advantage for the irradiation group with the limitation of large heterogeneity and a lack of statistical significance.

Conclusion:

Present data are poor and exhibit limited internal and external validity; thus, direct comparison was not possible with the eligible studies. Therefore, a meta-analysis of present data may not serve as the basis for a general treatment recommendation but underlines the need of prospective, randomized, controlled clinical trials.

Key Words

pN1 Head and neck Cancer Radiation Prognosis Meta-analysis 

Wirksamkeit der postoperativen Strahlentherapie bei Patienten mit kleinem oralen und oropharyngealen Plattenepithelkarzinom und solitärer, ipsilateraler zervikaler Lymphknotenmetastase (pN1). Eine Meta-Analyse

Hintergrund:

Der positive Effekt der Strahlentherapie für Patienten mit fortgeschrittenem Plattenepithelkarzinom im Kopf-Hals-Bereich ist wissenschaftlich gut belegt. Die vorliegende Arbeit überprüft, ob eine Meta-Analyse publizierter Daten die Wirksamkeit der postoperativen Strahlentherapie auch bei Patienten mit kleinem oralen oder oropharyngealen Plattenepithelkarzinom (pT1, pT2) und gleichzeitiger solitärer Lymphknotenmetastase (pN1) bewerten kann.

Methoden:

In die Meta-Analyse wurden randomisierte und nicht-randomisierte Studien eingeschlossen. Patienten mit hohem Risikoprofil wurden primär von der Studie ausgeschlossen und sind definiert durch Tumorgröße ≥ pT3/pT4, positivem Lymphknotenbefall ≥ pN2 oder Vorhandensein zusätzlicher histologischer Risikofaktoren, wie z.B. R1-Status, Lymphknotenkapseldurchbruch oder Lymphangiosis carcinomatosa. Das Primärziel war die Sterblichkeit zwischen den Behandlungsarmen.

Ergebnisse:

Lediglich eine prospektiv randomisierte Studie und sechs retrospektive Beobachtungsstudien standen zur Verfügung. Die deskriptive Analyse erbrachte eine leicht erhöhte Mortalität im Bestrahlungsarm (44% vs. 34%). Demgegenüber erbrachte die Forest-Plot-Darstellung von zwei Studien, die Ereignisse sowohl in Kontroll- und Therapiearm besaßen, einen begrenzten Vorteil für die Bestrahlungsgruppe, jedoch mit der Einschränkung großer Heterogenität und einem Mangel an statistischer Signifikanz.

Schlussfolgerung:

Es gibt nur wenige Publikationen zum Thema mit geringer interner und externer Validität, so dass ein direkter Vergleich nur eingeschränkt möglich ist. Die Meta-Analyse ist daher derzeit keine geeignete Basis für eine allgemeine Behandlungsempfehlung und unterstreicht die Notwendigkeit von prospektiv randomisierten klinischen Studien.

Schlüsselwörter

pN1 Kopf und Hals Karzinom Bestrahlung Prognose Meta-Analyse 

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Copyright information

© Urban & Vogel, Muenchen 2011

Authors and Affiliations

  • Maximilian Moergel
    • 1
  • Philipp Meurer
    • 1
  • Katharina Ingel
    • 2
  • Thomas G. Wendt
    • 3
  • Bilal Al-Nawas
    • 1
    • 4
  1. 1.Department of Oral and Maxillofacial SurgeryJohannes Gutenberg University, Medical CenterMainzGermany
  2. 2.Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)Johannes Gutenberg University, Medical CenterMainzGermany
  3. 3.Department of Radiation OncologyUniversity of Jena, Medical CenterJenaGermany
  4. 4.Department of Oral and Maxillofacial SurgeryJohannes Gutenberg University Mainz, Medical CenterMainzGermany

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