992PD - Residual neck disease (RND) management in squamous-cell carcinoma of the head and neck (SCCHN) treated with radiotherapy (RT) plus cetuximab (C)

Date 28 September 2014
Event ESMO 2014
Session Head and neck cancer
Topics Anti-Cancer Agents & Biologic Therapy
Head and Neck Cancers
Surgery and/or Radiotherapy of Cancer
Presenter Robert Montal
Citation Annals of Oncology (2014) 25 (suppl_4): iv340-iv356. 10.1093/annonc/mdu340
Authors R. Montal1, L. De Avila2, M. Taberna1, M. Oliva1, A. Rovira3, M. Cos4, M. Mañós3, V. Navarro5, J. Nogués3, A. Lozano6, S. Vázquez7, R. Mesia7
  • 1Medical Oncology Department, Institut Català d'Oncologia (ICO) Hospitalet, 08098 - Hospitalet de Llobregat, Barcelona/ES
  • 2Medical Oncology Department, Hospital Provincial Castellon, Castellón de la plana, Castellón/ES
  • 3Department Of Ent. Idibell. Head And Neck Cancer Unit., Hospital Universitari de Bellvitge (HUB), 08098 - Hospitalet de Llobregat, Barcelona/ES
  • 4Department Of Radiology. Head And Neck Cancer Unit., Hospital Universitari de Bellvitge (HUB), 08098 - Hospitalet de Llobregat, Barcelona/ES
  • 5Clinical Research Unit, Institut Català d'Oncologia (ICO) Hospitalet, 08098 - Hospitalet de Llobregat, Barcelona/ES
  • 6Radiation Oncology Department. Idibell. Head And Neck Cancer Unit., Institut Català d'Oncologia (ICO)-Hospitalet, 08098 - Hospitalet de Llobregat, Barcelona/ES
  • 7Medical Oncology Department. Idibell. Head And Neck Cancer Unit., Institut Català d'Oncologia (ICO)-Hospitalet, 08098 - Hospitalet de Llobregat, Barcelona/ES

Abstract

Aim

RND is one of the unsolved points in the bioradiotherapy of locoregionally advanced SCCHN. After this treatment, neck dissection (ND) could entail morbidity taking into account that sometimes it doesn't evidence disease on pathologic examination. In consequence, we tend to avoid this surgical procedure when we achieve nodal complete response (CR) by computed tomography (CT). In addition, positron-emission tomography (PET) tries to improve the decision for RND.

Methods

We retrospectively reviewed 202 patients (35% with severe comorbidity) consecutively diagnosed with node-positive SCCHN (24 N1, 152 N2 and 26 N3) and who had been treated with RT + C +/- induction chemotherapy between 2006-2013. Treatment radiological response was assessed by standard criteria using cervical CT. We focused on the management of RND, appraising the usefulness of PET in this situation from their implementation in 2010.

Results

CR was achieved by 118 (58%) patients, observing in this group a median overall survival (OS) of 48.3 months and 3-year loco-regional control of 62%. There were 42 (21%) patients who achieved CR of the primary tumor persisting radiological lymph node disease. From this group, 24 (57%) patients were managed without PET, leading to perform ND in 22 patients (92%), 10 of them with no evidence of disease on histological lymph node examination, observing a median OS of 33.3 months with only 1 post-surgical complication. On the other hand, 18 (43%) patients underwent PET, leading to perform ND in 6 patients (33%), 3 of them with no evidence of disease, observing a median OS of 34.7 months. Basing on this data, PET obtained a positive predictive value of 56% and a negative predictive value of 89%. The median OS for patients who underwent ND with histological confirmation of RND was 24.3 months. With a median follow-up of 30 months, median OS of all patients was 36 months.

Conclusions

The neck's pattern of response after bioradiotherapy seems to be different from the classical response with chemoradiotherapy, we perform many unnecessary ND in order to treat suspected RND. In this situation, PET may be useful to eliminate a remarkable amount of ND and its complications because of its high negative predictive value.

Disclosure

M. Taberna: Lectures funded by Merck S.L.; R. Mesia: Advisory board and lectures funded by Merck S.L. All other authors have declared no conflicts of interest.