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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

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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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.

Author information

Authors and Affiliations

  1. ENT, Service ORL, Chirurgie cervico-maxillo-faciale et audiophonologie, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France

    Florent Carsuzaa MD, Denis Tonnerre MD & Xavier Dufour MD, PhD

  2. Radiotherapy, Centre François Baclesse/ARCHADE, Caen, France

    Juliette Thariat MD, PhD

  3. Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France

    Philippe Gorphe MD

  4. ENT, CHU Grenoble, La Tronche, France

    Christian Righini MD, PhD

  5. ENT, CHU Lyon, Lyon, France

    Alain Cosmidis MD

  6. Radiotherapy, Centre Henri Becquerel, Rouen, France

    Sébastien Thureau MD, PhD & Maximilien Roge MD

  7. ENT, CHU Bordeaux Pellegrin, Bordeaux, France

    Erwan De Mones MD, PhD

  8. Radiotherapy, Centre Jean Godinot, Reims, France

    Stéphanie Servagi-Vernat MD, PhD

  9. ENT, CHU Tours, Tours, France

    Sylvain Morinière MD, PhD

  10. ENT, CHU Caen, Caen, France

    Amaury Dugas MD

  11. ENT, CHU Nantes, Nantes, France

    Olivier Malard MD, PhD & François Pasquier MD

  12. ENT, Institut Universitaire du Cancer de Toulouse Oncopole – CHU de Toulouse, Toulouse, France

    Sébastien Vergez MD, PhD

  13. Cellule Data Biostatistique, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-Lès-Nancy, France

    Julia Salleron MSc

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  1. Florent Carsuzaa MD
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Correspondence to Xavier Dufour MD, PhD.

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Carsuzaa, F., Thariat, J., Gorphe, P. et al. Surgery or Radiotherapy of the Primary Tumor in T1–2 Head and Neck Squamous Cell Carcinoma with Resectable N3 Nodes: A Multicenter GETTEC Study. Ann Surg Oncol 26, 3673–3680 (2019). https://doi.org/10.1245/s10434-019-07589-0

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