Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience
Abstract Background The patterns of nodal relapse in submandibular gland carcinoma (SMGC) patients treated with postoperative radiotherapy (PORT) remain unclear. This study aims to investigate the nodal failure patterns and the utility of elective nodal irradiation (ENI) in SMGC patients undergoing...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-09-01
|
| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-018-1130-y |
| _version_ | 1819083953059921920 |
|---|---|
| author | Cheng-En Hsieh Li-Yu Lee Yung-Chih Chou Kang-Hsing Fan Ngan-Ming Tsang Joseph Tung-Chieh Chang Hung-Ming Wang Shu-Hang Ng Chun-Ta Liao Tzu-Chen Yen Ku-Hao Fang Chien-Yu Lin |
| author_facet | Cheng-En Hsieh Li-Yu Lee Yung-Chih Chou Kang-Hsing Fan Ngan-Ming Tsang Joseph Tung-Chieh Chang Hung-Ming Wang Shu-Hang Ng Chun-Ta Liao Tzu-Chen Yen Ku-Hao Fang Chien-Yu Lin |
| author_sort | Cheng-En Hsieh |
| collection | DOAJ |
| description | Abstract Background The patterns of nodal relapse in submandibular gland carcinoma (SMGC) patients treated with postoperative radiotherapy (PORT) remain unclear. This study aims to investigate the nodal failure patterns and the utility of elective nodal irradiation (ENI) in SMGC patients undergoing PORT. Methods We retrospectively enrolled 65 SMGC patients who underwent PORT between 2000 and 2014. The nodal failure sites in relation to irradiation fields and pathological parameters were analyzed. ENI regions were categorized into three bilateral echelons (first, levels I–II; second, level III; and third, levels IV–V). Extended ENI was defined as coverage of at least the immediately adjacent uninvolved echelons bilaterally; otherwise, limited ENI was administered. Results Thirty patients (46%) were stage III–IV, and 18 (28%) were pN+. Neck irradiation included limited (72%) and extended ENI (28%). With a median follow-up of 79 months, 11 patients (17%) developed nodal failures (ipsilateral, N = 6; contralateral, N = 7), 7 (64%) of whom relapsed in the adjacent uninvolved echelons. We identified pN+ (P = 0.030), extranodal extension (ENE, P = 0.002), pT3–4 (P = 0.021), and lymphovascular invasion (LVI, P = 0.004) as significant predictors of contralateral neck recurrence. Extended ENI significantly improved regional control (RC) in patients with pN+ (P = 0.003), ENE (P = 0.022), pT3–4 (P = 0.044), and LVI (P = 0.014), and improved disease-free survival (DFS) in patients with pN+ (P = 0.034). For patients with ≥2 coincident adverse factors, extended ENI significantly increased RC (P < 0.001), distant metastasis-free survival (P = 0.019), and DFS (P = 0.007); conversely, no nodal recurrence was observed in patients without these adverse factors, even when only the involved echelon was irradiated. Conclusions Nodal failure is not uncommon in SMGC patients treated with PORT if pN+, ENE, pT3–4, and LVI are present. Extended ENI should be considered, particularly in patients with multiple pathological adverse factors. |
| first_indexed | 2024-12-21T20:40:45Z |
| format | Article |
| id | doaj.art-f094180e6a8d4c82a55ee8d529083217 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-21T20:40:45Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-f094180e6a8d4c82a55ee8d5290832172022-12-21T18:50:59ZengBMCRadiation Oncology1748-717X2018-09-0113111210.1186/s13014-018-1130-yNodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experienceCheng-En Hsieh0Li-Yu Lee1Yung-Chih Chou2Kang-Hsing Fan3Ngan-Ming Tsang4Joseph Tung-Chieh Chang5Hung-Ming Wang6Shu-Hang Ng7Chun-Ta Liao8Tzu-Chen Yen9Ku-Hao Fang10Chien-Yu Lin11Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityPathology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityRadiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityRadiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityRadiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityRadiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityMedical Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityDiagnostic Radiology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityOtorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityNuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityOtorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityRadiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung UniversityAbstract Background The patterns of nodal relapse in submandibular gland carcinoma (SMGC) patients treated with postoperative radiotherapy (PORT) remain unclear. This study aims to investigate the nodal failure patterns and the utility of elective nodal irradiation (ENI) in SMGC patients undergoing PORT. Methods We retrospectively enrolled 65 SMGC patients who underwent PORT between 2000 and 2014. The nodal failure sites in relation to irradiation fields and pathological parameters were analyzed. ENI regions were categorized into three bilateral echelons (first, levels I–II; second, level III; and third, levels IV–V). Extended ENI was defined as coverage of at least the immediately adjacent uninvolved echelons bilaterally; otherwise, limited ENI was administered. Results Thirty patients (46%) were stage III–IV, and 18 (28%) were pN+. Neck irradiation included limited (72%) and extended ENI (28%). With a median follow-up of 79 months, 11 patients (17%) developed nodal failures (ipsilateral, N = 6; contralateral, N = 7), 7 (64%) of whom relapsed in the adjacent uninvolved echelons. We identified pN+ (P = 0.030), extranodal extension (ENE, P = 0.002), pT3–4 (P = 0.021), and lymphovascular invasion (LVI, P = 0.004) as significant predictors of contralateral neck recurrence. Extended ENI significantly improved regional control (RC) in patients with pN+ (P = 0.003), ENE (P = 0.022), pT3–4 (P = 0.044), and LVI (P = 0.014), and improved disease-free survival (DFS) in patients with pN+ (P = 0.034). For patients with ≥2 coincident adverse factors, extended ENI significantly increased RC (P < 0.001), distant metastasis-free survival (P = 0.019), and DFS (P = 0.007); conversely, no nodal recurrence was observed in patients without these adverse factors, even when only the involved echelon was irradiated. Conclusions Nodal failure is not uncommon in SMGC patients treated with PORT if pN+, ENE, pT3–4, and LVI are present. Extended ENI should be considered, particularly in patients with multiple pathological adverse factors.http://link.springer.com/article/10.1186/s13014-018-1130-ySubmandibular gland cancerPostoperative radiotherapyElective nodal irradiationNodal failure pattern |
| spellingShingle | Cheng-En Hsieh Li-Yu Lee Yung-Chih Chou Kang-Hsing Fan Ngan-Ming Tsang Joseph Tung-Chieh Chang Hung-Ming Wang Shu-Hang Ng Chun-Ta Liao Tzu-Chen Yen Ku-Hao Fang Chien-Yu Lin Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience Radiation Oncology Submandibular gland cancer Postoperative radiotherapy Elective nodal irradiation Nodal failure pattern |
| title | Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience |
| title_full | Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience |
| title_fullStr | Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience |
| title_full_unstemmed | Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience |
| title_short | Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience |
| title_sort | nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy a multicenter experience |
| topic | Submandibular gland cancer Postoperative radiotherapy Elective nodal irradiation Nodal failure pattern |
| url | http://link.springer.com/article/10.1186/s13014-018-1130-y |
| work_keys_str_mv | AT chengenhsieh nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT liyulee nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT yungchihchou nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT kanghsingfan nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT nganmingtsang nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT josephtungchiehchang nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT hungmingwang nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT shuhangng nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT chuntaliao nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT tzuchenyen nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT kuhaofang nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience AT chienyulin nodalfailurepatternsandutilityofelectivenodalirradiationinsubmandibularglandcarcinomatreatedwithpostoperativeradiotherapyamulticenterexperience |