scholarly journals Radiation Therapy Impact on Lymph Node Yield in Patients With Laryngeal Squamous Cell Carcinoma

2019 ◽  
Vol 98 (5) ◽  
pp. 283-286
Author(s):  
Camilo Reyes ◽  
Julian Rios ◽  
Michael Groves ◽  
C. Arturo Solares ◽  
Lana Jackson ◽  
...  

Background: A lymph node yield (LNY) over 20 is considered a quality metric for lateral neck dissection to ensure an oncologic representative sample. Anecdotally, however, LNY in patients undergoing neck dissection after radiation therapy (RT) is lower due to atrophy and fibrosis. Objective: To determine whether preoperative RT decreases LNY in patients with laryngeal cancers undergoing surgery. Methods: Medical record database was queried for patients presenting between 2006 and 2015 with laryngeal cancer. Tabulation was made for location (glottic/supraglottic), stage, and side for the total number of lymph nodes between primary surgery and RT (salvage surgery) groups. Descriptive analysis and a paired Student t test were used for statistical analysis. Results: Fifty-nine patients were included in the study for a total of 98 neck dissections. Twenty-six (44%) patients had primary surgery, and 33 (56%) patients had salvage surgery. The mean left and right total LNY in the salvage surgery group was 27.6 and 29.5, respectively, and 32.2 and 33.7 for the primary surgery group. A difference of 4.5 (left) and 4.3 (right) in LNY between the salvage surgery and primary surgery group was found. A Student t test showed no statistically significant difference in LNY between both groups when analyzed per site (glottic and supraglottic), side, and stage (III-IV). Conclusion: Although patients with prior RT had a lower mean of LNY, our results did not demonstrate a statistically significant difference. Further studies with a larger number of patients are recommended.

2020 ◽  
pp. 000348942096482
Author(s):  
Michael C. Topf ◽  
Ramez Philips ◽  
Joseph Curry ◽  
Linda C. Magana ◽  
Madalina Tuluc ◽  
...  

Objectives: To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. Methods: Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. Results: Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes ( P < .001). In primary TL patients, age ( P < .001) and positive margins ( P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS ( P = .009). No LNY cutoff provided significant OS or DFS benefit. Conclusions: Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients. Level of Evidence: 4


2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
J Harris ◽  
CA Fleming ◽  
MF Ullah ◽  
E McNamara ◽  
S Murphy ◽  
...  

Abstract Introduction International guidelines recommend a minimum lymph node yield (LNY) of ≥12 for oncological resection in colorectal cancer (CRC). Neoadjuvant chemoradiotherapy (NACRT) decreases LNY, which questions its ability to provide accurate prognostic information. The consensus of this significance remains undetermined. This study aimed to investigate the significance of LNY on recurrence and survival following anterior resection and abdominoperineal resection with or without NACRT for rectal cancer. Method Prospectively collected data on patients diagnosed with rectal cancer in a tertiary referral centre was interrogated retrospectively. Patients were divided into primary surgery and NACRT groups. Univariable analysis was performed using Fisher's exact test, t-test, and x2 test, while multivariable analysis utilised a multiple regression model. Disease recurrence and survival was analysed with logrank test for Kaplan-Meier curves. Result 148 patients were included [56.1% (n=83) receiving NACRT]. The median LNY of the primary surgery group was 14 [interquartile range (IQR) 11-19] and for the NACRT group was 12 (IQR 8-14) (p &lt;0.001). Disease recurrence was similar in both primary surgery and NACRT groups. There was a significant decrease in overall mortality in NACRT patients (p = 0.03), but there was no significant difference observed in recurrence or mortality amongst LNYs of &lt;8, 8-11, and ≥12. Conclusion LNY less than 12 was not a negative prognostic indicator following NACRT and surgery for rectal cancer. Take-home message A lymph node yield of less than 12 is not a negative prognostic indicator in rectal cancer patients who receive neoadjuvant chemotherapy.


Author(s):  
K Devaraja ◽  
K Pujary ◽  
B Ramaswamy ◽  
D R Nayak ◽  
N Kumar ◽  
...  

Abstract Background Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. Methods This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. Results From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). Conclusion Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.


2020 ◽  
pp. 019459982093663
Author(s):  
Ernest D. Gomez ◽  
Joyce C. Chang ◽  
John J. Ceremsak ◽  
Robert M. Brody ◽  
Jason A. Brant ◽  
...  

Objectives (1) To estimate the association between neck dissection lymph node yield (LNY) and survival among patients with surgically treated human papilloma virus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC). (2) To identify a clinically relevant quality metric for surgical treatment of HPV-related OPSCC. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods From the National Cancer Database, 4130 patients were identified with HPV-associated OPSCC treated with primary surgery from 2010 to 2016. Based on prior literature, an adequate neck dissection LNY was defined as ≥18 lymph nodes. To determine whether LNY is associated with survival, univariable and multivariable Cox proportional hazards regression was performed. Analysis was stratified by adjuvant therapy regimen. Results A total of 2113 patients (51.2%) underwent surgery with or without adjuvant radiation (S ± RT), and 2017 patients (48.8%) underwent surgery with adjuvant chemoradiation. LNY ≥18 was associated with a 5-year survival benefit of 7.15% (91.7% for LNY ≥18, 84.5% for LNY <18, P = .004) for the S ± RT cohort on unadjusted survival analysis. For the S ± RT group, LNY ≥18 was associated with decreased hazard of death (hazard ratio, 0.45; 95% CI, 0.29-0.70; P < .001) after adjustment for patient characteristics, TNM staging, surgical margins, extranodal extension, and treating facility characteristics. For surgery with adjuvant chemoradiation, the adjusted hazard ratio estimate for LNY ≥18 was 0.64 (95% CI, 0.41-1.00), but the result was not statistically significant ( P = .052). Conclusion An adequate LNY from a neck dissection may affect survival when HPV-related OPSCC is treated with up-front surgery.


2019 ◽  
Vol 130 (3) ◽  
pp. 666-671 ◽  
Author(s):  
Joseph Zenga ◽  
Michael Stadler ◽  
Becky Massey ◽  
Bruce Campbell ◽  
Monica Shukla ◽  
...  

Head & Neck ◽  
2020 ◽  
Vol 42 (10) ◽  
pp. 2872-2879 ◽  
Author(s):  
Andrew J. Holcomb ◽  
Mollie Perryman ◽  
Sara Goodwin ◽  
Joseph Penn ◽  
Mark R. Villwock ◽  
...  

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