Abstract
Objective: Oropharyngeal cancer understanding has been greatly advanced with the discovery of the role of HPV. Nonsurgical approaches that utilize chemotherapy-radiotherapy have become common treatment. However, upfront surgery has recently gained momentum with the introduction of transoral approaches (laser/robotic). These approaches have been applied to all stages with excellent results.
Method: Determine the rate of extracapsular extension (ECE) in all patients with HPV+ oropharyngeal cancer (70 patients) treated with a neck dissection at our institution since pathologic HPV testing was first instituted (2006 to present).
Results: We looked at clinical features such as: T stage, primary site, clinical N-stage, node count, staging, sex, race, smoking, and features on preoperative imaging (cystic?, matted?, multiple nodes, number of nodes, and laterality). Of note we found a relationship between patients with lymph nodes >4 cm on pretreatment imaging having a statistically significant (P = .019) higher rate of extracapsular extension 47% (4cm). Clinical nodal stages related to rates of extracapsular extension with N1 (28.5% ECE), N2A (50% ECE), N2B (68.9% ECE), and N2C (75% ECE). We also noted that multiple nodes on final pathology also were associated with ECE. In specimens with one positive node, the incidence of ECE was 40.7% (P = .007).
Conclusion: One question in treating these patients with initial surgical approach is predicting who can avoid the toxic effects of radiation and/or chemotherapy. Chemotherapy is often added to the treatment in patients with positive margins and/or ECE. This information will assist in predicting which patients may benefit from a transoral surgery.
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