Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
MO_37_2858 - Uni or bilateral irradiation in cervical lymph node metastases of unknown primary?
Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3
Uni or bilateral irradiation in cervical lymph node metastases of unknown primary?
J. O. Thariat1, I. Troussier2, X. S. Sun3, J. Salleron4, C. Petit5, C. Pflumio4, B. Arnaud6, S. V. Stephanie7, J. Castelli8, J. Miroir9, M. Krengli10, P. Giraud11, J. Khalifa12, M. Dore13, N. Blanchard14, A. Coutte15, S. Sumodhee16, V. Calugaru17, Y. TAO18, C. Dupin19, Y. Pointreau20, S. H. Patel21, A. rehalia-Blanchard22, L. Catteau23, R. J. Bensadoun24, V. Roth25, and F. jean Christophe4; 1Centre Baclesse, Caen, France, 2chuv, lausanne, France, 3chbm, montbeliard, France, 4cav, nancy, France, 5igr, villejuif, France, 6curie, paris, France, 7institut godinot, reims, France, 8Centre Eugene Marquis, rennes, France, 9Department of radiotherapy, Centre Jean Perrin, 56 rue Montalembert 63011, Clermont-Ferrand, France, 10Department of Radiotherapy, University Hospital, Novara 28100, Italy, 11CHU Tenon, Paris, France, 12Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France, 13ICO Rene Gauducheau, Department of Radiation Oncology, Saint Herblain, France, 14Les Dentellieres, valenciennes, France, 15Department of radiotherapy, CHU Amiens, Picardie Avenue René Laënnec Salouel, 80054, Amiens, France, 16Centre Bergonie, bordeaux, France, 17Institut Curie, Paris, France, 18Institut Gustave Roussy, Villejuif, France, 19University Hospital of Bordeaux, Bordeaux, France, 20Centre Jean Bernard, le mans, France, 21Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, 22chu, saint etienne, France, 23CHU, Poitiers, France, 24centre Hautes Energies, nice, France, 25easy crf, france, France
Purpose/Objective(s): patients with cervical lymphadenopathies of unknown primary carcinoma (CUP) usually undergo neck dissection and irradiation. There is an ongoing controversy regarding the extent of nodal and mucosal volumes to be irradiated. We assessed outcomes after bilateral or unilateral nodal irradiation
Materials/Methods: this retrospective multicentric study included CUP-patients undergoing radiotherapy between 2000 and 2015.
Results: of 350 patients, 74.5% had unilateral disease. Sixty-one (20.5%) patients had unilateral disease and unilateral irradiation, 155 (52.2%) unilateral disease and bilateral irradiation and 81 (27.3%) bilateral disease and bilateral irradiation. Thirty-four (9.7%) and 217 (62.0%) patients had neoadjuvant and/or concomitant chemotherapy, respectively. Median follow-up was 37 months. Three-year local, regional, locoregional failure rates and CUP-specific survival were 5.6%, 11.7%, 15.0%, and 84.7%, respectively. In patients with unilateral disease, the 3-year cumulative incidence of regional / local relapse was 7.7%/4.3% after bilateral irradiation versus 16.9%/11.1% after unilateral irradiation (p=0.17/0.32). The cumulative incidence of cause-specific deaths was 9.2% after bilateral irradiation and 15.5% after unilateral irradiation (p=0.92). In multivariate analysis, mucosal irradiation was associated with better local control; while neck dissection, ≥N2b and interruption of radiotherapy for more than 4 days were associated with poorer regional control. Toxicity was higher after bilateral irradiation (p <0.05). PET-CT, largest node diameter, ≥N2b, interruption of radiotherapy and neoadjuvant chemotherapy were associated with poorer cause specific survival
Conclusion: Bilateral nodal irradiation yielded non-significant better nodal and mucosal control rates but was associated with higher rates of severe toxicity
Author Disclosure: J.O. Thariat: None. X. Sun: None. J. Salleron: None. C. Petit: None. C. Pflumio: None. B. Arnaud: None. M. Dore: None. A. rehalia-Blanchard: None. V. Roth: director; easy crf. F. jean Christophe: None.