Distribution of Cervical Lymph Node Metastases From Squamous Cell Carcinoma of the Upper Respiratory and Digestive Track

Department of Radiotherapy, The University of Texas at Houston M. D. Anderson Hospital and Tumor Institute, Houston, Tex.
Cancer (Impact Factor: 4.89). 06/1972; 29(6):1446 - 1449. DOI: 10.1002/1097-0142(197206)29:6<1446::AID-CNCR2820290604>3.0.CO;2-C


The records of 2,044 patients with previously untreated squamous cell carcinomas of the head and neck were reviewed in order to define the incidence and topographical distribution of lymph node metastasis on admission. The common regions of metastasis are presented for each of the seven individual head and neck sites selected for study. Knowledge of the preferred areas of spread and those that are almost never involved allows the design of more adequate plans to manage the individual lesions.

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    • "Oropharyngeal carcinomas are usually diagnosed as locoregionally advanced disease [8,9]. Thus, most of the primary tumours presents at an advanced stage (T2 or greater) [10], and the incidence of nodal metastases ranges between 60-70% [11,12] which is probably related to the rich lymphatic supply of the dominant subsites of the oropharyngeal cancers. "
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    ABSTRACT: Concurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The aim of this study was to analyse the results of three-dimensional conformal radiotherapy given with concomitant weekly cisplatin in patients with advanced oropharyngeal carcinoma and to identify prognostic factors influencing outcomes of this patients category. Sixty-five patients with stage III or IV squamous cell carcinoma of the oropharynx who underwent concurrent radiochemotherapy between January 2005 and December 2010 were retrospectively analyzed. All patients received radiotherapy to 70 Gy/35 fractions/2 Gy per fraction/5 fractions per week. Concurrent chemotherapy consisted of weekly cisplatin (30 mg/m(2)) started at the first day of radiotherapy. Median age was 57 years (range, 36 to 69 years) and 59 (90.8%) patients were male. Complete composite response was achieved in 47 patients (72.3%). Local and/or regional recurrence was the most frequent treatment failure present in 19 out of 25 patients (76.0%). At a median follow-up of 14 months (range, 5 to 72 months), 2-year local relapse-free, regional relapse-free, locoregional relapse-free, disease-free, and overall survival rates were 48.8%, 57.8%, 41.7%, 33.2% and 49.7%, respectively.On multivariate analysis the only significant factor for inferior regional relapse-free survival was the advanced N stage (p = 0.048). Higher overall stage was independent prognostic factor for poorer local relapse-free survival, locoregional relapse-free survival and disease-free survival (p = 0.022, p = 0.003 and p = 0.003, respectively). Pre-treatment haemoglobin concentration was an independent prognostic factor for local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, disease-free survival, and overall survival (p = 0.002, p = 0.021, p = 0.001, p = 0.002 and p = 0.002, respectively). Poor treatments results of this study suggested that introduction of intensity-modulated radiotherapy, use of induction chemotherapy followed by concurrent radiochemotherapy, accelerated radiotherapy regimens, and molecular targeted therapies could positively influence treatment outcomes. The incorporation of reversal of anaemia should be also expected to provide further improvement in locoregional control and survival in patients with advanced squamous cell carcinoma of the oropharynx.
    Full-text · Article · May 2012 · Radiation Oncology
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    • "The ability of PET-CT to accurately assess and be in accordance with prior studies of metastatic lymph node distribution is imperative for treatment planning of the N0 neck irrespective of the modality chosen. As previously reported, lymph node metastasis of OPSCC is most commonly seen at levels II and III [9,16,17]. PET-CT findings in this study are in agreement with this data confirming that PET-CT could accurately detect nodal disease in the staging of head and neck cancer patients. Furthermore, several studies have already shown that adding PET- FDG or PET/CT-FDG to standard work-up led to a higher staging accuracy with higher specificity [18-21]. "
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    ABSTRACT: Objective To study the retropharyngeal lymph node status (RPLN) by pretreatment PET-CT imaging in patients with squamous cell carcinomas of the oropharynx (OPSCC). Study Design: Retrospective. Methods 101 patients with a biopsy proven OPSCC were identified. 53 patients meeting inclusion criteria were further analyzed. Results The frequency of RPLN was 20.8% (11/53). Advanced T stage cancer (OR = 5.6250, 95% CI: 1.06 - 29.80, p = 0.0410) and advanced clinical N stage cancer (i.e. N2+) had higher odds (OR = 3.9773, 95% CI: 0.9628 - 16.4291) of being RPLN positive as compared to N0-1 patients. Conclusions Pre-treatment PET-CT can be used as a staging tool to aid in treatment planning of OPSCC, as rates of RPLN and nodal metastasis are consistent with those reported in the literature. Advanced T and N stage are associated with a greater odds ratio of being RPLN positive by PET-CT imaging.
    Full-text · Article · Aug 2010 · The Laryngoscope
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    • "The hypopharynx has an extensive lymphatic network. The lymphatic drainage of the hypopharynx is divided into anterior and posterior groups [10]. The anterior collecting system exits, along with the lymphatics of the supraglottic larynx, through the thyrohyoid membrane. "
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    ABSTRACT: The aim of this study was to analyze the prevalence and prognostic importance of paratracheal lymph nodes in squamous cell carcinoma of the hypopharynx. A retrospective review of 64 previously untreated patients with squamous cell carcinoma (SCC) of the hypopharynx that underwent surgery was performed. Ipsilateral paratracheal lymph node metastases occurred in 22% (14 out of 64) and the mean number of paratracheal lymph nodes dissected per side was 2.3 (range 1-6). Contralateral paratracheal lymph node metastases were present in 2% (1 out of 42). Sixty-seven percent with postcricoid SCC and 22% with pyriform sinus SCC developed clinical node-positive ipsilateral paratracheal lymph node metastases, whereas 11% with posterior pharyngeal wall SCC developed paratracheal metastases. There was a significant correlation between paratracheal lymph node metastasis and cervical metastasis (p = 0.005), and the primary tumor site (postcricoid, 57.1%; pyriform sinus, 20.0%; posterior pharyngeal wall, 8.3%) (p = 0.039). Patients with no evidence of paratracheal lymph node metastasis may have a survival benefit (5-year disease-specific survival rate, 60 vs. 29%). However, this result did not reach statistical significance (p = 0.071). The patients with SCC of the postcricoid and/or pyriform sinus were at risk for ipsilateral paratracheal lymph node metastasis; furthermore, patients with paratracheal node metastasis had a high frequency of cervical metastasis and a poorer prognosis. Therefore, routine ipsilateral paratracheal node dissection is recommended during the surgical treatment of patients with SCC of the postcricoid and/or pyriform sinus with clinical node metastases.
    Preview · Article · Dec 2009 · Archives of Oto-Rhino-Laryngology
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