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2 results

  • Residual cervical lymphadenopathy after definitive treatment of nasopharyngeal carcinoma: fine needle aspiration cytology, computed tomography and histopathological findings

  • S-T Toh, H-W Yuen, K-H Lim, Y-H Goh, H-K C Goh
  • Journal:
    The Journal of Laryngology & Otology / Volume 125 / Issue 1 / January 2011
    Published online by Cambridge University Press:
    27 September 2010, pp. 70-77
    Print publication:
    January 2011
    • Article
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  • Background:

    Patients with nasopharyngeal carcinoma may have residual cervical lymphadenopathy after definitive treatment of the primary tumour and regional cervical nodal disease. Whether such lymphadenopathy truly represents persistent disease is unclear. There are few published studies addressing this clinical problem.

    Methods:

    We retrospectively and systematically reviewed the clinical records of 12 patients with nasopharyngeal carcinoma who had presented to a tertiary academic hospital, over an 11-year period, with suspected persistent cervical nodal disease after definitive radiotherapy or concurrent chemoradiotherapy. Findings on fine needle aspiration cytology and computed tomography scanning were correlated with final histopathological results.

    Results:

    The incidence of negative neck dissection was 41.7 per cent. The positive and negative predictive values of fine needle aspiration cytology in identifying disease were 100 and 42.9 per cent, respectively. Computed tomography scanning had a positive predictive value of 58.3 per cent in identifying disease.

    Conclusion:

    In patients treated definitively for nasopharyngeal carcinoma, residual cervical lymphadenopathy may not represent persistent disease. Head and neck surgeons involved in the management of these patients should bear in mind the current limitations of fine needle aspiration cytology and computed tomography in confirming the diagnosis pre-operatively. Salvage neck dissection may over-treat some of these patients.

  • Postoperative radiotherapy for head and neck cancer with single positive node

  • Federico L. Ampil, Gloria Caldito, Cherie-Ann Nathan, Ghali Ghali, Roxana Baluna, Stephen Jones
  • Journal:
    Journal of Radiotherapy in Practice / Volume 9 / Issue 1 / March 2010
    Published online by Cambridge University Press:
    25 February 2010, pp. 27-31

  • The essential need for postoperative irradiation in people with carcinoma of the upper aerodigestive tract and limited metastatic nodal spread is controversial. An experience with postoperative radiotherapy in head and neck cancer (HNC) patients with one histologically positive cervical node is presented. Between 1976 and 2000, 37 individuals with confirmed metastatic disease in a single neck node underwent postoperative radiotherapy. The median follow-up period was 24 months. Among the 35 evaluable patients, the observed failure rates at the primary site, neck and distant location were 11%, 15% and 6%, respectively. The overall 5-year relapse-free survival rate was 60%. The relapse-free survival rate at 5 years was 86% in individuals who did not have additional histopathological risk factors and 55% in those patients who did (p = 0.46). The precise role of postoperative radiotherapy in people with HNC and documented metastasis in a single cervical lymph node remains to be defined including the identification of select individuals who may truly benefit from the combined therapy program.