Journal
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Volume 78, Issue 5, Pages 1366-1372Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ijrobp.2009.09.043
Keywords
Head and neck cancer; Lymph node metastases; Extracapsular extension; Radiation therapy; Prognosis
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Purpose Small lymph nodes (LN) show evidence of extracapsular extension (ECE) in a significant number of patients This study was performed to determine the Impact of ECE in LN <= 7 mm as compared with ECE in larger LN Methods and Materials All tumor positive LN of 74 head and neck squamous cell carcinoma (HNSCC) patients with at least one ECE positive LN were analyzed retrospectively for the LN diameter and the extent of ECE Clinical endpoints were regional relapse free survival, distant metastasis free survival, and overall survival The me than follow up for the surviving patients was 2 1 years (range, 0 3-9 2 years) Results Forty four of 74 patients (60%) had at least one ECE positive LN <= 10 mm These small ECE positive LN had a median diameter of 7 mm, which was used as a cutoff Thirty patients (41%) had at least one ECE positive LN <= 7 mm In both univariate and multivariate Cox regression analyses, the incidence of at least one ECE positive LN <= 7 mm was a statistically significant prognostic factor for decreased regional relapse free survival (adjusted hazard ratio [HR] 2 7, p = 0 03, 95% confidence Interval [CI] 1 1-6 4), distant metastasis free survival (HR 2 6,p = 004, 95% CI 1 0-6 6), and overall survival (HR 2 5,p = 003, 95% CI 1 1-5 8) Conclusions The incidence of small ECE positive LN metastases is a significant prognostic factor in HNSCC patients Small ECE positive LN may represent more invasive tumor biology and could be used as prognostic markers (C) 2010 Elsevier Inc
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