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Surgery or Radiotherapy of the Primary Tumor in T1–2 Head and Neck Squamous Cell Carcinoma with Resectable N3 Nodes: A Multicenter GETTEC Study

  • Florent Carsuzaa
  • Juliette Thariat
  • Philippe Gorphe
  • Christian Righini
  • Alain Cosmidis
  • Sébastien Thureau
  • Maximilien Roge
  • Erwan De Mones
  • Stéphanie Servagi-Vernat
  • Denis Tonnerre
  • Sylvain Morinière
  • Amaury Dugas
  • Olivier Malard
  • François Pasquier
  • Sébastien Vergez
  • Julia Salleron
  • Xavier DufourEmail author
Head and Neck Oncology

Abstract

Background

The prognosis of advanced nodal (N3) squamous cell carcinoma of the head and neck (HNSCC) is poor. We investigated whether surgery or radiotherapy of early (T1–2) primary stage HSNCC is preferable to limit the overall morbidity after upfront neck dissection (uND) for N3 disease.

Methods

This retrospective multicentric Groupe d’Étude des Tumeurs de la Tête Et du Cou study included patients undergoing uND and surgery or radiotherapy of their primary. Prognostic factors were evaluated using propensity score matching to account for biases in performing surgery depending on primary site and stage.

Results

Of 189 T1–2, N3 HNSCC patients, 70 (37.0%) underwent uND: 42 with surgery of their primary and 28 with radiotherapy only. Radiotherapy alone was more frequent in patients with hypopharyngeal primaries. All local (N = 3) and regional (N = 10) relapses (included 2 locoregional relapses) occurred within the first 2 years. There were 16 distant metastatic failures. Five-year locoregional relapse and survival incidences were 15.7% and 66.5% and were similar regardless of the treatment of the primary. The overall morbidity rate was 65.2% and was similar after weighting by the inverse propensity score (p = 0.148). The only prognostic factor for morbidity was the radicality of the uND. Prolonged parenteral feeding was not more frequent in patients only irradiated to their primary (p = 0.118). Prolonged tracheostomy was more frequent after surgery of the primary.

Conclusions

In patients with T1–2, N3 HNSCC undergoing uND, radiotherapy and surgery of the primary yield similar oncological outcomes. Morbidity was related to the extent of neck dissection.

Notes

Acknowledgements

Awarded best presentation at the SCFFC 2017 and presented at the SFRO 2018 and the SFORL 2018. Accepted for oral communication at the congress of European ORL-HNS Brussels 2019. The authors acknowledge the Cooperative group of French head and neck surgeons (Groupe d’Etude des Tumeurs de la Tête et du Cou, GETTEC), and http://www.easy-crf.com for secured encrypted collection and extraction of the database. This manuscript has been reviewed and edited by a native English speaker.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Florent Carsuzaa
    • 1
  • Juliette Thariat
    • 2
  • Philippe Gorphe
    • 3
  • Christian Righini
    • 4
  • Alain Cosmidis
    • 5
  • Sébastien Thureau
    • 6
  • Maximilien Roge
    • 6
  • Erwan De Mones
    • 7
  • Stéphanie Servagi-Vernat
    • 8
  • Denis Tonnerre
    • 1
  • Sylvain Morinière
    • 9
  • Amaury Dugas
    • 10
  • Olivier Malard
    • 11
  • François Pasquier
    • 11
  • Sébastien Vergez
    • 12
  • Julia Salleron
    • 13
  • Xavier Dufour
    • 1
    Email author
  1. 1.ENT, Service ORL, Chirurgie cervico-maxillo-faciale et audiophonologieCHU de PoitiersPoitiersFrance
  2. 2.RadiotherapyCentre François Baclesse/ARCHADECaenFrance
  3. 3.Department of Head and Neck Oncology, Gustave RoussyUniversity Paris-SaclayVillejuifFrance
  4. 4.ENTCHU GrenobleLa TroncheFrance
  5. 5.ENTCHU LyonLyonFrance
  6. 6.RadiotherapyCentre Henri BecquerelRouenFrance
  7. 7.ENTCHU Bordeaux PellegrinBordeauxFrance
  8. 8.RadiotherapyCentre Jean GodinotReimsFrance
  9. 9.ENTCHU ToursToursFrance
  10. 10.ENTCHU CaenCaenFrance
  11. 11.ENTCHU NantesNantesFrance
  12. 12.ENTInstitut Universitaire du Cancer de Toulouse Oncopole – CHU de ToulouseToulouseFrance
  13. 13.Cellule Data Biostatistique, Institut de Cancérologie de LorraineUniversité de LorraineVandœuvre-Lès-NancyFrance

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