Enfermedad ganglionar residual tras quimiorradioterapia con intención radical en pacientes con tumores de faringolaringe
Resumen Introducción y objetivo: La afectación ganglionar cervical es el principal factor pronóstico en el carcinoma epidermoide de cabeza y cuello. La cirugía de rescate se considera la intervención más curativa para la enfermedad residual o recurrente tras el tratamiento con quimiorradioterapia. Los objetivos del estudio fueron describir los datos epidemiológicos de los pacientes, valorar la utilidad de las pruebas de imagen, analizar la supervivencia y realizar una revisión de la bibliografía actual. Método: Se realizó un estudio retrospectivo en el que se incluyeron pacientes intervenidos de cirugía ganglionar cervical entre enero de 2010 y diciembre de 2015, con sospecha radiológica de enfermedad ganglionar persistente, tras haber recibido tratamiento quimio-radioterápico con intención radical por presentar un carcinoma de faringe o laringe. Resultados: Se incluyeron 30 pacientes. La localización tumoral más común fue la supraglotis (13). El resultado histológico más frecuente fue de carcinoma epidermoide pobremente y moderadamente diferenciado (10 casos en cada uno). El 60% de los pacientes presentaban un estadio IVa. El valor predictivo positivo (VPP) de la TAC fue de 55,26%. El 87,5% de las histologías que confirmaron la sospecha diagnóstica radiológica en una primera cirugía ocurrieron en los pacientes a los que se les había realizado una TAC de forma precoz. La supervivencia global fue del 53,33%, terminando el 40% de los pacientes libres de enfermedad al final del periodo. Conclusiones: El bajo VPP de la TAC hace replantear su utilidad como método para valorar respuesta ganglionar a la quimiorradioterapia. Parece razonable plantear la realización de vaciamientos ganglionares selectivos en pacientes seleccionados.
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American Joint Committee on Cancer. AJCC cancer staging manual, 7th ed. New York: Springer, 2012.
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Forest VI, Nguyen-Tan PF, Tabet JC, Olivier MJ, Larochelle D, Fortin B, et al. Role of neck dissection following concurrent chemoradiation for advanced head and neck carcinoma. Head Neck 2006;28(12):1099–105. https://doi.org/10.1002/hed.20479 - PMid:16933313
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Mandapathil M, Roessler M, Werner JA, Silver CE, Rinaldo A, Ferlito A. Salvage surgery for head and neck squamous cell carcinoma. Eur Arch Oto Rhino Laryngol. 2014;271(7):1845-50. https://doi.org/10.1007/s00405-014-3043-1 - PMid:24756615
Nayak JV, Walvekar RR, Andrade RS, Daamen N, Lai SY, Argiris A, et al. Deferring planned neck dissection following chemoradiation for stage IV Head and Neck Cancer: The Utility of PET-TC. Laryngoscope 2007 Dec;117(12): 2129-34. https://doi.org/10.1097/MLG.0b013e318149e6bc - PMid:17921898
Nishimura G, Yabuki K, Hata M, Komatsu M, Taguchi T, Takahasi M, et al. Imaging strategy for response evaluation to chemoradiotherapy of the nodal disease in patients with head and neck squamous cell carcinoma. Int J Clin Oncol 2005; 21(4): 658-667. https://doi.org/10.1007/s10147-015-0936-y - PMid:26710795
Ojiri, Mancuso AA, Mendenhall WM, Stringer SP. Lymph nodes of patients with regional metastases from head and neck squamous cell carcinoma as a predictor of pathologic outcome: size changes at CT before and after radiation therapy. AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1627-31. - PMid:12427611
Robbins KT, Doweck I, Samant S, Vieira F. Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation. Arch Otolaryngol Head Neck Surg 2005;131(11):965–9. https://doi.org/10.1001/archotol.131.11.965 - PMid:16301367
Ryan WR, Fee Jr WE, Le QT, Pinto HA. Positron-emission tomography for surveillance of head and neck cancer. Laryngoscope. 2005;115(4):645–50. doi:10.1097/01.mlg.0000161345.23128.d4. https://doi.org/10.1097/01.mlg.0000161345.23128.d4
Thariat J, Ang KK, Allen PK, Ahamad A, Williams MD, Myers JN, et al. Prediction of neck dissection requirement after definitive radiotherapy for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2012;82(3):e367–74. https://doi.org/10.1016/j.ijrobp.2011.03.062 - PMid:22284033 PMCid:PMC4124997
Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. New Engl J Medicine. 2008;359(11):1116–27. https://doi.org/10.1056/NEJMoa0802656 - PMid:18784101
Brizel DM, Prosnitz RG, Hunter S, Fisher SR, Clough RL, Downey MA, et al. Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004;58(5):1418–23. https://doi.org/10.1016/j.ijrobp.2003.09.004 - PMid:15050318
Cannady SB, Lee WT, Scharpf J, Lorenz RR, Wood BG, Strome M, et al. Extent of neck dissection required after concurrent chemoradiation for stage IV head andneck squamous cell carcinoma. Head Neck 2010;32(3):348–56. - PMid:19672875
Corry J, Peters L, Fisher R, Macann A, Jackson M, McClure B, et al. N2–N3 neck nodal control without planned neck dissection for clinical/radiologic complete responders-results of Trans Tasman Radiation Oncology Group Study 98.02. Head Neck 2008;30(6):737–42. https://doi.org/10.1002/hed.20769 - PMid:18286488
Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46(4):765-81. https://doi.org/10.1016/j.ejca.2009.12.014 - PMid:20116997
Ferlito A, Corry J, Silver CE, Shaha AR, Thomas Robbins K, Rinaldo A. Planned neck dissection for patients with compLete response to chemoradiotherapy: a concept approaching obsolescence. Head Neck. 2010;32(2):253–61. - PMid:19572281
Forest VI, Nguyen-Tan PF, Tabet JC, Olivier MJ, Larochelle D, Fortin B, et al. Role of neck dissection following concurrent chemoradiation for advanced head and neck carcinoma. Head Neck 2006;28(12):1099–105. https://doi.org/10.1002/hed.20479 - PMid:16933313
Goguen LA, Posner MR, Tishler RB, Wirth LJ, Norris CM, Annino DJ, et al.Examining the need for neck dissection in the era of chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 2006;132(5):526–31. https://doi.org/10.1001/archotol.132.5.526 - PMid:16702569
Hamoir M, Ferlito A, Schmitz S, Hanin FX, Thariat J, Weynand B, et al. The role of neck dissection in the setting of chemoradiation therapy for head and neck squamous cell carcinoma with advanced neck disease. Oral Oncol 2012;48(3):203–10. https://doi.org/10.1016/j.oraloncology.2011.10.015 - PMid:22104248
Hermann RM, Christiansen H, Rödel RM. Lymph node positive head and neck carcinoma after curative radiochemotherapy: a long lasting debate on elective post-therapeutic neck dissections comes to conclusion. Cancer Radiother 2013; 17:323-331. https://doi.org/10.1016/j.canrad.2013.01.018 - PMid:23706533
Karakaya E, Yetmen O, Colpan Oksuz D, Dyker KE, Coyle C, Sen M, et al. Outcomes following chemoradiotherapy for N3 head and neck squamous cell carcinoma without a planned neck dissection. Oral Oncol 2013 Jan;49(1):55-9. https://doi.org/10.1016/j.oraloncology.2012.07.010 - PMid:22858313
Kim R, Ock CY, Keam B, Kim TM, Kim JH, Paeng JC, et al. Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head and neck squamous cell carcinoma: a retrospective study. BMC Cancer 2016 Feb 17; 16: 116. https://doi.org/10.1186/s12885-016-2147-y - PMid:26884055 PMCid:PMC4756525
Lambrecht M, Dirix P, Van den Bogaert W, Nuyts S. Incidence of isolatedregional recurrence after definitive (chemo-)radiotherapy for head and necksquamous cell carcinoma. Radiother Oncol 2009;93(3):498–502. https://doi.org/10.1016/j.radonc.2009.08.038 - PMid:19766340
Lee JC, Kim JS, Lee JH, Nam SY, Choi SH, Lee SW, et al. F-18 FDG-PET as a routine surveillance tool for the detection of recurrent head and neck squamous cell carcinoma. Oral Oncol. 2007;43(7):686–92. https://doi.org/10.1016/j.oraloncology.2006.08.006 - PMid:17112775
Mandapathil M, Roessler M, Werner JA, Silver CE, Rinaldo A, Ferlito A. Salvage surgery for head and neck squamous cell carcinoma. Eur Arch Oto Rhino Laryngol. 2014;271(7):1845-50. https://doi.org/10.1007/s00405-014-3043-1 - PMid:24756615
Nayak JV, Walvekar RR, Andrade RS, Daamen N, Lai SY, Argiris A, et al. Deferring planned neck dissection following chemoradiation for stage IV Head and Neck Cancer: The Utility of PET-TC. Laryngoscope 2007 Dec;117(12): 2129-34. https://doi.org/10.1097/MLG.0b013e318149e6bc - PMid:17921898
Nishimura G, Yabuki K, Hata M, Komatsu M, Taguchi T, Takahasi M, et al. Imaging strategy for response evaluation to chemoradiotherapy of the nodal disease in patients with head and neck squamous cell carcinoma. Int J Clin Oncol 2005; 21(4): 658-667. https://doi.org/10.1007/s10147-015-0936-y - PMid:26710795
Ojiri, Mancuso AA, Mendenhall WM, Stringer SP. Lymph nodes of patients with regional metastases from head and neck squamous cell carcinoma as a predictor of pathologic outcome: size changes at CT before and after radiation therapy. AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1627-31. - PMid:12427611
Robbins KT, Doweck I, Samant S, Vieira F. Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation. Arch Otolaryngol Head Neck Surg 2005;131(11):965–9. https://doi.org/10.1001/archotol.131.11.965 - PMid:16301367
Ryan WR, Fee Jr WE, Le QT, Pinto HA. Positron-emission tomography for surveillance of head and neck cancer. Laryngoscope. 2005;115(4):645–50. doi:10.1097/01.mlg.0000161345.23128.d4. https://doi.org/10.1097/01.mlg.0000161345.23128.d4
Thariat J, Ang KK, Allen PK, Ahamad A, Williams MD, Myers JN, et al. Prediction of neck dissection requirement after definitive radiotherapy for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2012;82(3):e367–74. https://doi.org/10.1016/j.ijrobp.2011.03.062 - PMid:22284033 PMCid:PMC4124997
Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. New Engl J Medicine. 2008;359(11):1116–27. https://doi.org/10.1056/NEJMoa0802656 - PMid:18784101
Galindo-Torres, B. P., El Uali-abeida, M., Llano-Espinosa, M., Vives-RicomÀ, E., Rebolledo-Bernad, L., De Miguel-garcía, F., & Fernández-Liesa, R. (2017). Enfermedad ganglionar residual tras quimiorradioterapia con intención radical en pacientes con tumores de faringolaringe. Revista ORL, 8(4), 205–210. https://doi.org/10.14201/orl.16052
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