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Human Papillomavirus-Associated Oropharyngeal Cancer: Patterns of Nodal Disease.

Authors
  • Plonowska, Karolina A1
  • Strohl, Madeleine P2
  • Wang, Steven J3
  • Ha, Patrick K4
  • George, Jonathan R4
  • Heaton, Chase M4
  • El-Sayed, Ivan H4
  • Mallen-St Clair, Jon5
  • Ryan, William R4
  • 1 1 School of Medicine, University of California-San Francisco, San Francisco, California, USA.
  • 2 2 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA.
  • 3 3 Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Phoenix, Arizona, USA.
  • 4 4 Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA.
  • 5 5 Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
Type
Published Article
Journal
Otolaryngology
Publisher
SAGE Publications
Publication Date
Mar 01, 2019
Volume
160
Issue
3
Pages
502–509
Identifiers
DOI: 10.1177/0194599818801907
PMID: 30274544
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To characterize patterns of neck lymph node (LN) metastases in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma, represented by p16 positivity (p16+OPSCC). Case series with chart review. Tertiary care center. Neck dissection (ND) specimens of nonirradiated p16+OPSCC patients were analyzed for frequencies of clinically evident and occult LNs by neck level. Local, regional, and distant recurrences were reviewed. Seventy p16+OPSCC patients underwent primary site transoral robotic surgery and 82 NDs of varying levels. Metastatic pathologic LNs were found at the following frequencies: 0% (0/28) in level I, 75.6% (62/82) in level II with 57.4% (35/61) in level IIA and 13.1% (8/61) in level IIB, 22.0% (18/82) in level III, 7.0% (5/71) in level IV, and 6.3% (1/16) in level V. The level V LN was clinically evident preoperatively. Five of 21 (23.8%) elective NDs contained occult LNs, all of which were in level II and without extranodal extension. Twenty-seven (38.6%) patients underwent adjuvant radiation; 19 (27.1%) patients underwent adjuvant chemoradiation. With a mean follow-up of 29 months, 3 patients had developed recurrences, with all but 1 patient still alive. All patients who recurred had refused at least a component of indicated adjuvant treatment. For p16+OPSCC, therapeutic NDs should encompass any levels bearing suspicious LNs and levels IIA-B, III, and IV, while elective NDs should be performed and encompass at least levels IIA-B and III. These selective ND plans, followed by indicated adjuvant treatment, are associated with a low nodal recurrence rate.

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