Prognostic Value of Radiological Extranodal Extension Detected by Computed Tomography for Predicting Outcomes in Patients With Locally Advanced Head and Neck Squamous Cell Cancer Treated With Radical Concurrent Chemoradiotherapy

• DOI: 10.3389/fonc.2022.814895
• Publication Date: 2022-06-01T07:35:35Z
• Authors: Abhishek Mahajan; Ankur Chand; Ujjwal Agarwal; Vijay Patil; Richa Vaish; Vanita Noronha; Amit Joshi; Akhil Kapoor; Nilesh Sable; Ankita Ahuja; Shreya Shukla; Nandini Menon; Jai Prakash Agarwal; Sarbani Ghosh Laskar; Anil D’ Cruz; Pankaj Chaturvedi; Devendra Chaukar; P. S. Pai; Gouri Pantvaidya; Shivakumar Thiaga...; Swapnil Rane; Kumar Prabhash
• Keywords: Chemoradiotherapy

Objective Extra Nodal Extension (ENE) assessment in locally advanced head and neck cancers (LAHNCC) treated with concurrent chemo radiotherapy (CCRT) is challenging hence the American Joint Committee on Cancer (AJCC) N staging. We hypothesized that radiology-based ENE (rENE) may directly impact outcomes LAHNSCC radical CCRT. Materials Methods Open-label, investigator-initiated, randomized controlled trial (RCT) (2012–2018), which included planned for Patients were 1:1 to (66–70 grays) weekly cisplatin (30 mg/m 2 ) [cisplatin radiation arm (CRT)] or same schedule of CRT nimotuzumab (200 mg) [nimotuzumab plus (NCRT)]. A total 536 patients accrued 182 excluded due non-availability Digital Imaging Communications Medicine (DICOM) computed tomography (CT) data. 354 analyzed rENE. Metastatic nodes evaluated based five criteria further classified as rENE positive/negative three-criteria capsule irregularity fat stranding, invasion, muscle/vessel invasion. association disease-free survival (DFS), loco-regional recurrence-free (LRRFS), overall (OS). Results 244 (68.9%) had radiologically metastatic (rN), out 140 (57.3%) Distribution was balanced two study groups NCRT (p-value 0.412). The median follow-up period 39 months (ranging from 35.5 42.8 months). Complete response (CR) seen 204 (57.6%); incomplete (IR), i.e., partial stable disease (PR + SD), 126 (35.6%); progressive (PD) 24 (6.8%). rENE-positive group poor compared rENE-negative 3-year OS (46.7% vs. 63.6%), DFS (48.8% 87%), LRRFS (39.9% 60.4%). positive 1.71 times increased risk IR than negative. Overall stage, site, clinical node (cN), response, significant factors predicting OS, DFS, univariate analysis. After making adjustment multivariate analysis, an independent prognostic factor trending be OS. Conclusion Pre-treatment marker radically CCRT can used a potential predictive treatment stratify into responders non-responders. propose mahajan grading system applicable CT, magnetic resonance imaging, positron emission tomography–contrast-enhanced ultrasound.