Surgery or Radiotherapy of the Primary Tumor in T1–2 Head and Neck Squamous Cell Carcinoma with Resectable N3 Nodes: A Multicenter GETTEC Study
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.
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.
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.
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.
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.
- 4.Geoffrois L, Martin L, De Raucourt D, Sun XS, Tao Y, Maingon P, et al. Induction chemotherapy followed by cetuximab radiotherapy is not superior to concurrent chemoradiotherapy for head and neck carcinomas: results of the GORTEC 2007-02 phase III randomized trial. J Clin Oncol. 2018:JCO2017762591.Google Scholar
- 6.Haddad R, O’Neill A, Rabinowits G, Tishler R, Khuri F, Adkins D, et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol. 2013;14(3):257–64.CrossRefPubMedGoogle Scholar
- 7.Mehanna H, McConkey CC, Rahman JK, Wong WL, Smith AF, Nutting C, et al. PET-NECK: a multicentre randomised phase III non-inferiority trial comparing a positron emission tomography-computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer. Health Technol Assess. 2017;21(17):1–122.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Corry J, Peters L, Fisher R, Macann A, Jackson M, McClure B, et al. N2–N3 neck nodal control without planned neck dissection for clinical/radiologic complete responders-results of Trans Tasman Radiation Oncology Group Study 98.02. Head Neck. 2008;30(6):737–42.Google Scholar
- 15.Dequanter D, Lothaire P, Awada A, Lalami Y, Hien Nguyen T, Lemort M, et al. Does clinical and radiological response predict complete tumor control in N2–N3 squamous cell head and neck cancer after non-operative management of the neck? Acta Otolaryngol. 2006;126(11):1225–8.CrossRefPubMedGoogle Scholar
- 19.Lee DJ, Cosmatos D, Marcial VA, Fu KK, Rotman M, Cooper JS, et al. Results of an RTOG phase III trial (RTOG 85-27) comparing radiotherapy plus etanidazole with radiotherapy alone for locally advanced head and neck carcinomas. Int J Radiat Oncol Biol Phys. 1995;32(3):567–76.CrossRefPubMedGoogle Scholar
- 25.D’Cruz A K, Pantvaidya GH, Agarwal JP, Chaukar DA, Pathak KA, Deshpande MS, et al. Split therapy: planned neck dissection followed by definitive radiotherapy for a T1, T2 pharyngolaryngeal primary cancer with operable N2, N3 nodal metastases–a prospective study. J Surg Oncol. 2006;93(1):56–61.CrossRefPubMedGoogle Scholar
- 26.Laccourreye O, Malinvaud D, Holostenco V, Menard M, Garcia D, Bonfils P. Value and limits of non-robotic transoral oropharyngectomy for local control of T1-2 invasive squamous cell carcinoma of the tonsillar fossa. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(3):141–6.CrossRefPubMedGoogle Scholar
- 27.Thariat J, Hamoir M, Garrel R, Cosmidis A, Dassonville O, Janot, et al. Management of the neck in the setting of definitive chemoradiation: Is there a consensus? A GETTEC study. Ann Surg Oncol. 2012;19(7):2311–9.Google Scholar