Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary

Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy,...

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Vydáno v:	Cancers Ročník 13; číslo 10; s. 2416
Hlavní autoři:	Abu-Shama, Yazan, Salleron, Julia, Carsuzaa, Florent, Sun, Xu-Shan, Pflumio, Carole, Troussier, Idriss, Petit, Claire, Caubet, Matthieu, Beddok, Arnaud, Calugaru, Valentin, Servagi-Vernat, Stephanie, Castelli, Joël, Miroir, Jessica, Krengli, Marco, Giraud, Paul, Romano, Edouard, Khalifa, Jonathan, Doré, Mélanie, Blanchard, Nicolas, Coutte, Alexandre, Dupin, Charles, Sumodhee, Shakeel, Tao, Yungan, Roth, Vincent, Geoffrois, Lionel, Toussaint, Bruno, Nguyen, Duc Trung, Faivre, Jean-Christophe, Thariat, Juliette
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Basel MDPI AG 17.05.2021 MDPI
Témata:	Cancer Cancer therapies Chemotherapy Dissection Head & neck cancer Head and neck carcinoma Life Sciences Medical prognosis Metastasis Multivariate analysis Otolaryngology Patients Radiation therapy Santé publique et épidémiologie Squamous cell carcinoma Toxicity United States > US unknown primary chemoradiotherapy head and neck neck dissection neoplasms/cancers/carcinomas prognosis
ISSN:	2072-6694, 2072-6694
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Abstract	Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage. Results: 53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. Conclusion: In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage.
AbstractList	Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP.PURPOSEManagement of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP.A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage.METHODSA retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage.53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND.RESULTS53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND.In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage.CONCLUSIONIn HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage. Simple SummaryA retrospective multicentric study of 322 patients with head and neck cancers of unknown primary (HNCUP) was performed testing the impact of neck dissection (ND) extent on nodal relapse, progression-free survival and survival. After 5 years, the incidence of nodal relapse was 13.4%, and progression-free survival (PFS) was 59.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective ND or radical/modified ND but survival rates were similar. Patients undergoing lymphadenectomy or ND had significantly better PFS and a lower nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. In HNCUP, ND improves PFS regardless of nodal stage but fails to improve survival. The magnitude of the benefit of ND did not appear to depend on ND extent and decreased with a more advanced nodal stage.AbstractPurpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage. Results: 53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. Conclusion: In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage. Simple Summary: A retrospective multicentric study of 322 patients with head and neck cancers of unknown primary (HNCUP) was performed testing the impact of neck dissection (ND) extent on nodal relapse, progression-free survival and survival. After 5 years, the incidence of nodal relapse was 13.4%, and progression-free survival (PFS) was 59.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective ND or radical/modified ND but survival rates were similar. Patients undergoing lymphadenectomy or ND had significantly better PFS and a lower nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. In HNCUP, ND improves PFS regardless of nodal stage but fails to improve survival. The magnitude of the benefit of ND did not appear to depend on ND extent and decreased with a more advanced nodal stage.Abstract: Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP.Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage. Results: 53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. Conclusion: In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage. Results: 53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. Conclusion: In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage.
Author	Blanchard, Nicolas Doré, Mélanie Geoffrois, Lionel Faivre, Jean-Christophe Toussaint, Bruno Nguyen, Duc Trung Coutte, Alexandre Krengli, Marco Tao, Yungan Pflumio, Carole Giraud, Paul Carsuzaa, Florent Castelli, Joël Sumodhee, Shakeel Roth, Vincent Dupin, Charles Caubet, Matthieu Troussier, Idriss Miroir, Jessica Thariat, Juliette Beddok, Arnaud Khalifa, Jonathan Sun, Xu-Shan Salleron, Julia Petit, Claire Calugaru, Valentin Abu-Shama, Yazan Servagi-Vernat, Stephanie Romano, Edouard
AuthorAffiliation	3 Department of Oto-Rhino-Laryngology—Head and Neck Surgery, Centre Hospitalier Régional Universitaire, 86021 Poitiers, France; florent.carsuzaa@gmail.com 10 Department of Radiotherapy, Institut Eugène Marquis, 35000 Rennes, France; j.castelli@rennes.unicancer.fr 13 Department of Radiotherapy, Centre Hospitalier Universitaire Tenon—Assistance Publique–Hôpitaux de Paris, 75020 Paris, France; p-giraud@outlook.fr (P.G.); ed-romano@hotmail.fr (E.R.) 21 Department of Radiotherapy, Institut de Cancérologie de Lorraine, 54519 Nancy, France; jeanchristophe.faivre@gmail.com 6 Centre des Hautes Energies, Department of Radiotherapy, 06000 Nice, France; idrisstroussier@hotmail.com (I.T.); Yungan.TAO@gustaveroussy.fr (Y.T.) 15 Department of Radiotherapy, Institut de Cancérologie de l’Ouest, 44800 Nantes, France; melanie.dore@ico.unicancer.fr 2 Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, 54519 Nancy, France; j.salleron@nancy.unicancer.fr 4 Department of Radiothera
AuthorAffiliation_xml	– name: 2 Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, 54519 Nancy, France; j.salleron@nancy.unicancer.fr – name: 13 Department of Radiotherapy, Centre Hospitalier Universitaire Tenon—Assistance Publique–Hôpitaux de Paris, 75020 Paris, France; p-giraud@outlook.fr (P.G.); ed-romano@hotmail.fr (E.R.) – name: 14 Department of Radiotherapy, Institut Universitaire du Cancer, 31100 Toulouse, France; jonathan.khalifa@hotmail.fr – name: 15 Department of Radiotherapy, Institut de Cancérologie de l’Ouest, 44800 Nantes, France; melanie.dore@ico.unicancer.fr – name: 11 Centre Jean Perrin, Department of Radiotherapy, 63011 Clermont-Ferrand, France; miroirjessica@hotmail.fr – name: 10 Department of Radiotherapy, Institut Eugène Marquis, 35000 Rennes, France; j.castelli@rennes.unicancer.fr – name: 22 Centre François Baclesse—Centre de Recherche Avancées d’Hadronthérapie Européenne, Department of Radiotherapy, University of Caen Normandie, 14000 Caen, France – name: 8 Department of Radiotherapy, Institut Curie, 75005 Paris, France; a.beddok@gmail.com (A.B.); valentin.calugaru@curie.fr (V.C.) – name: 18 Department of Radiotherapy, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France; charles.dupin@chu-bordeaux.fr – name: 21 Department of Radiotherapy, Institut de Cancérologie de Lorraine, 54519 Nancy, France; jeanchristophe.faivre@gmail.com – name: 7 Department of Radiotherapy, Institut Gustave Roussy, 94805 Villejuif, France; claire.petit@hotmail.fr – name: 4 Department of Radiotherapy, CHRU de Besançon—Montbéliard, 25000 Besançon, France; Xu-Shan.SUN@hnfc.fr (X.-S.S.); matthieu.caubet@gmail.com (M.C.) – name: 6 Centre des Hautes Energies, Department of Radiotherapy, 06000 Nice, France; idrisstroussier@hotmail.com (I.T.); Yungan.TAO@gustaveroussy.fr (Y.T.) – name: 16 Department of Radiotherapy, Clinique les Dentellières, 59300 Valenciennes, France; nicoblanchard@yahoo.fr – name: 17 Department of Radiotherapy, Centre Hospitalier Universitaire d’Amiens, 80000 Amiens, France; Coutte.Alexandre@chu-amiens.fr – name: 9 Department of Radiotherapy, Institut Jean Godinot, 51100 Reims, France; stephanie.servagi@gmail.com – name: 19 Centre Antoine Lacassagne, Department of Radiotherapy, 06000 Nice, France; shakeel.sumodhee@u-bordeaux.fr – name: 1 Department of Oto-Rhino-Laryngology—Head and Neck Surgery, Centre Hospitalier Régional Universitaire, Vandœuvre-Lès-Nancy, 54519 Nancy, France; yazan.abushama@gmail.com (Y.A.-S.); b.toussaint@chru-nancy.fr (B.T.); dtrungnguyen02@gmail.com (D.T.N.) – name: 12 Department of Radiotherapy, University of Piemonte Orientale, 27100 Pavia, Italy; marco.krengli@med.uniupo.it – name: 5 Department of Oncology, Institut de Cancérologie de Lorraine, 54519 Nancy, France; pflumiocarole@gmail.com (C.P.); l.geoffrois@nancy.unicancer.fr (L.G.) – name: 3 Department of Oto-Rhino-Laryngology—Head and Neck Surgery, Centre Hospitalier Régional Universitaire, 86021 Poitiers, France; florent.carsuzaa@gmail.com – name: 20 Easy CRF, 8 Rue Lecourtois, 14920 Mathieu, France; v.roth@easy-crf.com
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PublicationTitle	Cancers
PublicationYear	2021
Publisher	MDPI AG MDPI
Publisher_xml	– name: MDPI AG – name: MDPI
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Snippet	Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The... Simple SummaryA retrospective multicentric study of 322 patients with head and neck cancers of unknown primary (HNCUP) was performed testing the impact of neck... Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic... Simple Summary: A retrospective multicentric study of 322 patients with head and neck cancers of unknown primary (HNCUP) was performed testing the impact of...
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StartPage	2416
SubjectTerms	Cancer Cancer therapies Chemotherapy Dissection Head & neck cancer Head and neck carcinoma Life Sciences Medical prognosis Metastasis Multivariate analysis Otolaryngology Patients Radiation therapy Santé publique et épidémiologie Squamous cell carcinoma Toxicity
Title	Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary
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