Defining the Risk of Involvement for Each Neck Nodal Level in Patients With Early T-Stage Node-Positive Oropharyngeal Carcinoma

Giuseppe Sanguineti, Joseph Califano, Edward Stafford, Jana L. Fox, Wayne Koch, Ralph Tufano, Maria Pia Sormani, Arlene Forastiere

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Purpose: To assess the risk of ipsilateral subclinical neck nodal involvement for early T-stage/node-positive oropharyngeal squamous cell carcinoma. Methods and Materials: Patients undergoing multilevel upfront neck dissection (ND) at Johns Hopkins Hospital within the last 10 years for early clinical T-stage (cT1-2) node-positive (cN+) oropharyngeal squamous cell carcinoma were identified. Pathologic involvement of Levels IB-V was determined. For each nodal level, the negative predictive value of imaging results was computed by using sensitivity/specificity data for computed tomography (CT). This was used to calculate 1 - negative predictive value, or the risk that a negative level on CT harbors subclinical disease. Results: One hundred three patients met the criteria. Radical ND was performed in 14.6%; modified radical ND, in 70.9%; and selective ND, in 14.6%. Pathologic positivity rates were 9.5%, 91.3%, 40.8%, 18.0%, and 3.3% for Levels IB-V, respectively. Risks of subclinical disease despite negative CT imaging results were calculated as 3.1%, 76.3%, 17.5%, 6.3%, and 1.0% for Levels IB-V, respectively. Conclusions: Levels IB and V are at very low (<5%) risk of involvement, even with ipsilateral to pathologically proven neck disease; this can guide radiation planning. Levels II and III should be included in high-risk volumes regardless of imaging results, and Level IV should be included within the lowest risk volume.

Original languageEnglish (US)
Pages (from-to)1356-1364
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number5
DOIs
StatePublished - Aug 1 2009
Externally publishedYes

Fingerprint

Neck Dissection
Neck
cancer
Carcinoma
dissection
Tomography
tomography
Squamous Cell Carcinoma
harbors
Radiation
planning
Sensitivity and Specificity
sensitivity
radiation

Keywords

  • Intensity-modulated radiotherapy (IMRT)
  • Oropharyngeal cancer
  • Subclinical risk

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Defining the Risk of Involvement for Each Neck Nodal Level in Patients With Early T-Stage Node-Positive Oropharyngeal Carcinoma. / Sanguineti, Giuseppe; Califano, Joseph; Stafford, Edward; Fox, Jana L.; Koch, Wayne; Tufano, Ralph; Sormani, Maria Pia; Forastiere, Arlene.

In: International Journal of Radiation Oncology Biology Physics, Vol. 74, No. 5, 01.08.2009, p. 1356-1364.

Research output: Contribution to journalArticle

Sanguineti, Giuseppe ; Califano, Joseph ; Stafford, Edward ; Fox, Jana L. ; Koch, Wayne ; Tufano, Ralph ; Sormani, Maria Pia ; Forastiere, Arlene. / Defining the Risk of Involvement for Each Neck Nodal Level in Patients With Early T-Stage Node-Positive Oropharyngeal Carcinoma. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 74, No. 5. pp. 1356-1364.
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abstract = "Purpose: To assess the risk of ipsilateral subclinical neck nodal involvement for early T-stage/node-positive oropharyngeal squamous cell carcinoma. Methods and Materials: Patients undergoing multilevel upfront neck dissection (ND) at Johns Hopkins Hospital within the last 10 years for early clinical T-stage (cT1-2) node-positive (cN+) oropharyngeal squamous cell carcinoma were identified. Pathologic involvement of Levels IB-V was determined. For each nodal level, the negative predictive value of imaging results was computed by using sensitivity/specificity data for computed tomography (CT). This was used to calculate 1 - negative predictive value, or the risk that a negative level on CT harbors subclinical disease. Results: One hundred three patients met the criteria. Radical ND was performed in 14.6{\%}; modified radical ND, in 70.9{\%}; and selective ND, in 14.6{\%}. Pathologic positivity rates were 9.5{\%}, 91.3{\%}, 40.8{\%}, 18.0{\%}, and 3.3{\%} for Levels IB-V, respectively. Risks of subclinical disease despite negative CT imaging results were calculated as 3.1{\%}, 76.3{\%}, 17.5{\%}, 6.3{\%}, and 1.0{\%} for Levels IB-V, respectively. Conclusions: Levels IB and V are at very low (<5{\%}) risk of involvement, even with ipsilateral to pathologically proven neck disease; this can guide radiation planning. Levels II and III should be included in high-risk volumes regardless of imaging results, and Level IV should be included within the lowest risk volume.",
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AU - Stafford, Edward

AU - Fox, Jana L.

AU - Koch, Wayne

AU - Tufano, Ralph

AU - Sormani, Maria Pia

AU - Forastiere, Arlene

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N2 - Purpose: To assess the risk of ipsilateral subclinical neck nodal involvement for early T-stage/node-positive oropharyngeal squamous cell carcinoma. Methods and Materials: Patients undergoing multilevel upfront neck dissection (ND) at Johns Hopkins Hospital within the last 10 years for early clinical T-stage (cT1-2) node-positive (cN+) oropharyngeal squamous cell carcinoma were identified. Pathologic involvement of Levels IB-V was determined. For each nodal level, the negative predictive value of imaging results was computed by using sensitivity/specificity data for computed tomography (CT). This was used to calculate 1 - negative predictive value, or the risk that a negative level on CT harbors subclinical disease. Results: One hundred three patients met the criteria. Radical ND was performed in 14.6%; modified radical ND, in 70.9%; and selective ND, in 14.6%. Pathologic positivity rates were 9.5%, 91.3%, 40.8%, 18.0%, and 3.3% for Levels IB-V, respectively. Risks of subclinical disease despite negative CT imaging results were calculated as 3.1%, 76.3%, 17.5%, 6.3%, and 1.0% for Levels IB-V, respectively. Conclusions: Levels IB and V are at very low (<5%) risk of involvement, even with ipsilateral to pathologically proven neck disease; this can guide radiation planning. Levels II and III should be included in high-risk volumes regardless of imaging results, and Level IV should be included within the lowest risk volume.

AB - Purpose: To assess the risk of ipsilateral subclinical neck nodal involvement for early T-stage/node-positive oropharyngeal squamous cell carcinoma. Methods and Materials: Patients undergoing multilevel upfront neck dissection (ND) at Johns Hopkins Hospital within the last 10 years for early clinical T-stage (cT1-2) node-positive (cN+) oropharyngeal squamous cell carcinoma were identified. Pathologic involvement of Levels IB-V was determined. For each nodal level, the negative predictive value of imaging results was computed by using sensitivity/specificity data for computed tomography (CT). This was used to calculate 1 - negative predictive value, or the risk that a negative level on CT harbors subclinical disease. Results: One hundred three patients met the criteria. Radical ND was performed in 14.6%; modified radical ND, in 70.9%; and selective ND, in 14.6%. Pathologic positivity rates were 9.5%, 91.3%, 40.8%, 18.0%, and 3.3% for Levels IB-V, respectively. Risks of subclinical disease despite negative CT imaging results were calculated as 3.1%, 76.3%, 17.5%, 6.3%, and 1.0% for Levels IB-V, respectively. Conclusions: Levels IB and V are at very low (<5%) risk of involvement, even with ipsilateral to pathologically proven neck disease; this can guide radiation planning. Levels II and III should be included in high-risk volumes regardless of imaging results, and Level IV should be included within the lowest risk volume.

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