Author(s)
Hena Ahmed BS
Anuraag Parikh MD
Besher Assi MD
Sidharth Puram MD PhD
Mark Varvares MD
Affiliation(s)
Massachusetts Eye and Ear Infirmary
Abstract:
Educational Objective: At the conclusion of this presentation, participants should be able to compare outcomes following definitive management of the neck in HPV associated oropharyngeal squamous cell carcinoma with upfront neck dissection versus radiation therapy with or without chemotherapy, with neck dissection reserved for salvage. Objectives: To describe a single center experience with management of the neck in regionally metastatic HPV associated oropharyngeal squamous cell carcinoma (OPSCC), comparing regional control and survival outcomes with upfront neck dissection (ND) versus upfront radiation therapy (XRT) with or without chemotherapy. Study Design: Retrospective chart review. Methods: The institutional cancer registry was used to identify patients who underwent definitive management of the neck for HPV associated OPSCC between February 2000 and December 2014. Clinical and pathologic data were collected retrospectively and analyzed for their association with regional control, overall (OS) and disease free survival (DFS). Results: 90 patients with regionally metastatic disease were identified who underwent management of the neck with ND, XRT, or a combination of both. Mean age at diagnosis was 56.6 years and mean followup time was 59.1 months (SD 31.2). 43 patients underwent upfront ND, and of these patients 95% received postoperative XRT. 47 patients underwent upfront XRT to the neck, with or without chemotherapy, and of these patients 17% required subsequent ND for persistent disease in the neck. 5 and 10 year OS were 98% and 98% for upfront ND and 93% and 88% for upfront XRT. 5 and 10 year DFS were 93% and 81% for upfront ND and 86% and 86% for upfront XRT. Recurrence rates were 9.3% with upfront ND and 10.6% with upfront XRT. Conclusions: Our single center experience of 90 patients suggests that for management of the neck in regionally metastatic HPV associated OPSCC, regional control, OS, and DFS are comparable with upfront ND versus upfront XRT.