AbstractBackgroundPathologic extracapsular extension (pECE) in metastatic lymph nodes is associated with poor prognosis for oropharyngeal carcinoma. The prognostic value of radiographic extracapsular extension (rECE) has not been studied.MethodsA retrospective analysis was conducted of 111 patients with locally advanced oropharyngeal carcinoma treated in the Mount Sinai Radiation Oncology Department with accessible pretreatment CT reports. Univariate Kaplan–Meier and multivariate Cox regression analyses compared cohorts for locoregional control, distant control, progression‐free (PFS), and overall survival (OS).ResultsSixty‐four patients had rECE‐present and 47 had rECE‐absent scans. The patients with rECE presence had significantly worse OS (3‐year: 95% vs 77%; p = .006), PFS (3‐year: 91% vs 71%; p = .002), and distant control (3‐year: 98% vs 81%; p = .008), with no difference in locoregional control. On multivariate analysis, rECE‐presence was a negative prognosticator for OS, PFS, and distant control.ConclusionThis study suggests that rECE is an independent prognosticator of poor distant control and survival with little impact on locoregional control for oropharyngeal carcinoma. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1689–1694, 2014