|Beitragstitel||Viable tumor cells in salvage neck dissections samples: prognostic impact residual nodal SUVmax|
Background: After primary chemoradiation in advanced oropharyngeal, laryngeal and/or hypopharyngeal cancer, nodal disease may require a salvage neck dissection. However, salvage neck dissection is associated with increased morbidity and may only be required in case of persistence of viable tumor cells, which is virtually impossible to confirm or exclude using fine needle aspiration cytology. We therefore aimed to identify predictive factors for the persistence of viable tumor cells after chemoradiation for head and neck squamous cell cancer.
Methods: We performed a retrospective review of neck dissections specimens performed after primary (chemo)radiation for oropharyngeal, laryngeal or hypopharyngeal squamous cell carcinoma. All patients were treated at University Hospital Zurich from 2007 to 2016.
Results: A total of 78 patients were included. Thirty-eight patients (48.7%) had viable tumor cells in the neck dissection sample. Smoking, p16 negativity and high nodal SUVmax were predictors of viable tumor cells in salvage neck dissections (Mann Whitney U/Chi-squared test, P=0.030, P=0.025, and P < 0.001, respectively). Patients with viable tumor cells showed a significantly worse locoregional recurrence-free, distant metastasis-free and disease-specific survival (Log rank-test, P < 0.001).
Conclusion: This study shows a highly significant correlation between viable tumor cells in neck dissections and a poor survival outcome. This indicates that salvage neck dissection may provide important prognostic information but may not lead to improved survival.