Pre- and Post-Radiotherapy Radiologic Nodal Features and Oropharyngeal Cancer Outcomes
Thiparom Sananmuang MD
Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine, Ramathibodi Hospital/Mahidol University, Bangkok, Thailand
Search for more papers by this authorEugene Yu MD
Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
These authors contributed equally to this work.
Search for more papers by this authorJie Su MSc
Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9 Canada
Search for more papers by this authorBrian O'Sullivan MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorShrinivas Rathod MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Radiation Oncology, CancerCare Manitoba/University of Manitoba, Winnipeg, Manitoba, Canada
Search for more papers by this authorBiu Chan MSc
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorEric Bartlett MD
Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJohn Waldron MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJolie Ringash MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJohn Kim MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorScott V. Bratman MD, PhD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAndrew Hope MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAnna Spreafico MD
Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAaron R. Hansen MD
Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJohn de Almeida MD
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorDavid P. Goldstein MD, MSc
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorIan Witterick MD
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorLi Tong BSc
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorWei Xu PhD
Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9 Canada
Search for more papers by this authorCorresponding Author
Shao H. Huang MD, MSc, MRT(T)
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
These authors contributed equally to this work.
Send correspondence to Shao Hui Huang, MD, MRT(T), Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada. E-mail: [email protected]
Search for more papers by this authorThiparom Sananmuang MD
Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine, Ramathibodi Hospital/Mahidol University, Bangkok, Thailand
Search for more papers by this authorEugene Yu MD
Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
These authors contributed equally to this work.
Search for more papers by this authorJie Su MSc
Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9 Canada
Search for more papers by this authorBrian O'Sullivan MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorShrinivas Rathod MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Radiation Oncology, CancerCare Manitoba/University of Manitoba, Winnipeg, Manitoba, Canada
Search for more papers by this authorBiu Chan MSc
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorEric Bartlett MD
Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJohn Waldron MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJolie Ringash MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJohn Kim MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorScott V. Bratman MD, PhD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAndrew Hope MD
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAnna Spreafico MD
Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAaron R. Hansen MD
Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJohn de Almeida MD
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorDavid P. Goldstein MD, MSc
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorIan Witterick MD
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorLi Tong BSc
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorWei Xu PhD
Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9 Canada
Search for more papers by this authorCorresponding Author
Shao H. Huang MD, MSc, MRT(T)
Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
These authors contributed equally to this work.
Send correspondence to Shao Hui Huang, MD, MRT(T), Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada. E-mail: [email protected]
Search for more papers by this authorEditor's Note: This Manuscript was accepted for publication on August 04, 2020.
Presented at the 53rd American Society of Head and Neck Radiology (ASHNR) Annual Meeting, Scottsdale, Arizona, U.S.A, October 2–6, 2019.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objectives
To assess the prognostic value of pre-/post-radiotherapy (pre-/post-RT) radiologic lymph node (LN) features in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal carcinoma (OPC) patients treated with definitive (chemo-)RT.
Methods
Clinical node-positive OPCs treated from 2011 to 2015 were reviewed. Nodal features were reviewed by a radiologist on pre-/post-RT computed tomography (CTs). Univariable analysis calculated hazard ratio (HR) for regional failure (RF), distant metastasis (DM), and deaths. Multivariable analysis estimated adjusted HR (aHR) of significant nodal features identified in univariable analysis adjusting for confounders.
Results
Pre-RT CT was undertaken in 344 HPV-positive and 94 HPV-negative OPC patients, of whom 242 (70%) HPV-positive and 67 (71%) HPV-negative also had a post-RT CT. Median follow-up was 4.9 years. Pre-RT LN calcification (pre-RT_LN-cal) increased the risk of RF in HPV-negative (aHR: 5.3, P = .007) but not HPV-positive patients (P = .110). Pre-RT radiologic extranodal extension (pre-RT_rENE+) increased the risk of DM and death in both HPV-negative (DM: aHR 6.6, P < .001; death: aHR 2.1, both P = .019) and HPV-positive patients (DM: aHR 4.9; death: aHR 3.0, both P < .001). Increased risk of RF occured with < 20% post-RT LN size reduction in both HPV-negative (HR 6.0, P = .002) and HPV-positive cases (HR 3.0, P = .049). Post-RT_LN-cal did not affect RF, DM, or death regardless of tumor HPV status (all P > .05).
Conclusion
Pre-RT_LN-cal is associated with higher RF risk in HPV-negative but not in HPV-positive patients. Pre-RT_rENE increases risk of DM and death regardless of tumor HPV status. Minimal post-RT LN size reduction (< 20%) increases risk of RF in both diseases. Post-RT_LN-cal + has no apparent influence on outcomes in either disease.
Level of Evidence
4 (a single institution case–control series) Laryngoscope, 131:E1162–E1171, 2021
Supporting Information
| Filename | Description |
|---|---|
| lary29045-sup-0001-Supinfo.pdfPDF document, 788.9 KB | Appendix S1 Supplement 1. Example of Radiologic Nodal Features and Calcification Types. A. Necrotic node: a lymph node (LN) with areas of heterogeneous low attenuation (10–25 HU) with thick irregular enhancing rim; B. A typical cystic node: Low-density lymph node with homogeneous near-water attenuation (<25 HU); C. Intranodal cystic changes: the presence of cystic focus in a LN; D. Extranodular extension (ENE): a LN with irregular margin and/or fat stranding; E. Coalescent nodes: LNs abutting one another with loss of intervening fat plane that is replaced with evidence of ENE; F. Micro-calcification: dot-like foci of calcification; G. Macro-calcification: coarse foci of calcification; H. Both micro- and macro-calcification: presence of both dot-like and chunky calcification. Supplement 2. CONSORT Diagram of Patients Included in the Analysis. Supplement 3. Inter-rater Concordance of Pre- and Post-RT Lymph Node Feature Assessment. Features in bold are selected for outcome analysis. Abbreviation: ENE: extranodal extension; LN: lymph node; RT: radiotherapy. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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