Journal
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Volume 74, Issue 5, Pages 1356-1364Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ijrobp.2008.10.018
Keywords
Subclinical risk; Oropharyngeal cancer; Intensity-modulated radiotherapy (IMRT)
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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 I - 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 11 and III should be included in high-risk volumes regardless of imaging results, and Level IV should be included within the lowest risk volume. (C) 2009 Elsevier Inc.
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