Contralateral Neck Recurrence Research Articles

179 Contralateral Neck Recurrence Following Unilateral Treatment for Oral Tongue Squamous Cell Carcinoma

179 Contralateral Neck Recurrence Following Unilateral Treatment for Oral Tongue Squamous Cell Carcinoma

Low contralateral neck recurrence risk with ipsilateral neck radiotherapy in N2b tonsillar squamous cell carcinoma

ObjectivesTo characterize factors including nodal burden, pre-treatment imaging, and other patient factors which may influence the role of ipsilateral neck radiotherapy (IRT) in tonsillar squamous cell carcinoma (SCC) with multiple involved ipsilateral nodes. MethodsPatients with cT1-2N0-2bM0 (AJCC 7th edition) tonsillar SCC treated with definitive radiation therapy (RT) at Duke University Medical Center from 1/1/1990–10/1/2019 were identified. Patient, tumor, and treatment characteristics were compared between those that received bilateral neck RT (BRT) versus IRT. Recurrence-free survival (RFS) was estimated with Kaplan-Meier method. A subset analysis of patients with N2b disease was performed. Patterns of recurrence were analyzed. Results120 patients with cT1-2N0-2b tonsillar SCC were identified, including 71 with N2b disease (BRT: n = 30; IRT: n = 41). Median follow-up was 80 months (range: 7–209). No N2b patients who received IRT had > 1 cm of soft palate/base of tongue extension. N2b patients treated with IRT had a median of 3 (range 2–9) involved lymph nodes, with median largest nodal dimension of 2.8 cm (range 1.3–4.8 cm). 93 % of N2b patients who received IRT had staging by PET/CT, and 100 % received IMRT. For N2b patients treated with IRT, there were no contralateral neck recurrences, and 10 year RFS was 95 % (95 % CI 82 %–98 %). ConclusionsFor patients treated with IRT for well-lateralized N2b tonsillar SCC, we observed high rates of local control with no observed contralateral neck recurrence. These data suggest that BRT is not universally necessary for patients with multiple involved ipsilateral nodes, particularly in the setting of baseline staging with PET/CT.

Contralateral neck nodal outcomes and recurrence pattern of small well-lateralized oral cavity carcinoma—a single institution experience

Contralateral neck nodal outcomes and recurrence pattern of small well-lateralized oral cavity carcinoma—a single institution experience

Contralateral Neck Irradiation Can Be Omitted for Selected Lateralized Oral Cancer in Locally Advanced Stage.

(1) Background: To investigate the contralateral neck failure (cRF) rates and outcomes among patients with well-lateralized locally advanced oral cavity squamous cell carcinoma (OSCC) with/without ipsilateral or bilateral neck adjuvant irradiation. (2) Methods: Patients with lateralized OSCC diagnosed between 2007 and 2017 were retrospectively enrolled. Patients who had undergone curative surgery with pathologically proven pT3/4 or pN0-2b without distant metastasis were included, while those with cross-midline, neck-level 1a involvement and positive extra-nodal extension (ENE) were excluded. The primary endpoint was the cumulative incidence of 5-year cRF as the first site of failure. The secondary endpoints included cancer-specific survival (CSS), local-regional recurrence-free survival (LRRFS), distant-metastasis-free survival (DMFS), and contralateral-regional recurrence-free survival (cRRFS). (3) Results: In total, 149 patients were analyzed with a median follow-up time of 5.2 years (range, 2.91–7.83). Pathological stages T3 and T4 were 22.7% and 56.8%, respectively. Pathologically negative and positive lymph nodes were 61.4% and 38.6%, respectively. The cumulative 5-year cRF rate was 3.6% (95% CI, 1.3–7.7%). No significant differences in the 5-year CSS, LRRFS, DMFS, and cRRFS were observed among those undergoing unilateral or bilateral neck irradiation. Five patients (3.4%) had contralateral neck recurrence, all simultaneously with local recurrence. No isolated contralateral neck recurrence was identified. (4) Conclusions: The cRF rate was acceptably low in patients with well-lateralized advanced OSCC with the initially uninvolved contralateral neck. Omitting contralateral neck irradiation with active surveillance could be considered without compromising the cure rate in locally advanced OSCC patients.

Adjuvant contralateral neck irradiation for oral cavity cancer - A systematic review and meta-analysis

IntroductionWhether contralateral neck irradiation should be administered for oral cavity cancer is a critical question because patients receiving bilateral neck irradiation experience more adverse effects. Patients not receiving contralateral neck irradiation are at risk of contralateral neck recurrence of oral cavity cancer Materials and MethodsMeta-analysis and subgroup analysis were performed for the rates of contralateral neck recurrence of oral cavity cancer in patients receiving no contralateral neck radiation. We aimed to identify the patient group suitable for contralateral neck radiotherapy omission. The PRISMA guideline was used for this study. We extracted data including the first author, country, sample size, numbers of patients receiving ipsilateral neck radiotherapy and experiencing contralateral neck recurrence, participant characteristics, and details of cancer types ResultsThe rate of contralateral neck recurrence is extremely low, 3.4% (95% confidence interval: 2.2%–5.4%). Isolated contralateral neck recurrence occurred in 18 of 524 patients receiving radiotherapy to the primary tumor site with or without ipsilateral irradiation. The subgroup analysis was conducted to investigate pathological lymph node stage and subsite. Subgroup analysis showed that the N2–3 group was more likely to exhibit recurrence in contralateral neck than the N0–1 group was (14.4% versus 1.5%, p = 0.0008). In addition, the contralateral neck recurrence rate was 6.3% (95% CI = 2.3%–13.1%) and 2.8% (95% CI = 1.5%–4.8%), in the tongue cancer patient group and the non-tongue cancer patient group, respectively. Meta-regression showed that the rate of contralateral recurrence was not different between both groups (p = 0.08). Only 2 exhibited isolated contralateral neck recurrence (5.1%) in pN0–1 tongue cancer patient. Most of them (>90%) are lateralized. ConclusionIn conclusion, the omission of contralateral irradiation is reasonable in pN0–1, well lateralized oral cavity cancer.

Ipsilateral versus Bilateral Neck Radiation Therapy for Tonsillar Squamous Cell Carcinoma

Ipsilateral neck radiation (I-RT) has been adopted for patients with early stage, well lateralized tonsillar squamous cell carcinoma (SCC), however there are limited data on outcomes of this approach in those with N2b disease. We report locoregional disease free survival (LR-DFS) for patients with tonsillar SCC who received I-RT or bilateral neck radiation (B-RT). Patients with tonsillar SCC who underwent definitive radiation, with or without chemotherapy, at a single academic institution between 3/1/90 and 10/15/18 were identified. Patient, tumor, and treatment characteristics were recorded. Stage was assigned per AJCC 7th ed. Wilcoxon Rank Sum and Chi-Square tests were used to compare patients who underwent either B-RT or I-RT. The primary outcome was locoregional disease-free survival (LR-DFS). Secondary outcomes were freedom from distant recurrence (FFDR) and overall survival (OS). Outcomes were estimated with Kaplan Meier method and compared via log rank test. Multivariate cox proportional hazards were used to estimate the effect of variables on endpoints. 216 patients with tonsillar SCC were treated with B-RT (n = 159) or I-RT (n = 57). Median age was 56 (IQR 51 – 64). Patients who underwent I-RT had T1 (45.6%) or T2 (54.4%) disease. Those who underwent B-RT had a higher proportion of T3/T4 disease: 8.2% T1, 25.8% T2, 42.8% T3, and 23.2% T4 disease (p<0.01). Most patients had nodal disease, I-RT: 3.5% N0, 19.3% N1, 14.0% N2a, 63.2% N2b and B-RT: 15.1% N0, 13.8% N1, 7.6% N2a, 36.5% N2b, 13.2% N2c, and 13.8% N3. HPV/p16 status for patients with B-RT was positive in 31.0%, negative in 2.0%, and unknown in 67.3%; for I-RT, HPV/p16 was positive in 59.6%, negative in 3.5%, and unknown in 36.8%. Median total dose to both groups was 70 Gy at 2 Gy/fraction. Concurrent chemotherapy was used in 94% of patients with B-RT and 77% with I-RT (p<0.01). 5-year estimates for survival endpoints are given below. On multivariate analysis controlling for T/N stage, use of chemotherapy, and HPV status, LR-DFS did not differ significantly for patients receiving B-RT versus I-RT (HR 0.67, 95% CI 0.40 – 4.10, p = 0.67). Among those treated with I-RT, 2 developed local recurrence at the primary tumor site. There were no ipsilateral or contralateral neck recurrences. Of 94 patients with N2b disease, 36 received I-RT. For those with N2b disease, 5-year LR-DFS was 93% (95% CI 73% – 98%) after I-RT versus 85% (95% CI 72% – 92%) after B-RT (p = 0.18). High rates of LR-DFS were achieved with I-RT for T1-T2 N0-2b tonsillar SCC, with no ipsilateral or contralateral neck recurrences. Use of I-RT did not compromise LR-DFS compared to B-RT. For patients with N2b disease, I-RT also resulted in high rates of LR-DFS. To our knowledge, this series represents the largest single institution cohort incorporating patients with tonsillar SCC and N2b disease treated with I-RT.Abstract 3868; TableB-RTI-RTLR-DFS (95% CI)78% (70-84%)91% (78-97%)FFDR (95% CI)89% (82-93%)96% (85-99%)OS (95% CI)71% (63-78%)91% (78-97%) Open table in a new tab

The contralateral based submental island flap for reconstruction of tongue and floor of mouth defects: Reliability and oncological outcome.

Submental artery island flap (SIF) is a viable alternative to free flaps for selected oral-cavity defects, however, concerns about its oncologic safety still exists. A novel harvesting technique and its outcome is described in here. This is a prospective study for patients with lateralized oral tongue and/or floor of mouth (FOM) cancers who undergone reconstruction using pedicled SIF based on contralateral submental vessels (CSIF) following resection. Forty-one patients were included. Twenty-four patients had T2, 13 had T3, and 4 had T1 tumors. The largest flap skin paddle was 15 × 9 cm. One patient sustained complete and five sustained partial flap loss. Three patients developed tongue tethering. Median follow-up was 13.6 months. Locoregional recurrence occurred in 11 patients (26.8%); 6 oral-cavity recurrences (14.6%), 6 ipsilateral, and 1 contralateral neck recurrences (2.4%). CSIF is a reliable flap that addresses the oncologic controversy and overcomes the disadvantages of ipsilateral flap.

Low risk of contralateral lymph node recurrence in lateralized head and neck carcinoma after postoperative ipsilateral radiotherapy.

The role of postoperative irradiation to contralateral non-involved neck nodes in lateralized carcinoma of the head and neck is not clear. The contralateral neck failure rate in head and neck carcinoma treated postoperatively with ipsilateral neck irradiation only was evaluated. Patients with carcinoma of the oral cavity, oropharynx, or hypopharynx without midline extension treated between 1990 and 2016 were analyzed. After tumor resection and neck dissection (ND), radiotherapy was given to the primary tumor site and ipsilateral neck. High-risk patients additionally received concurrent chemotherapy. Freedom from contralateral neck recurrence (FCNR), locoregional control rate (LRC), overall survival (OS), and disease-free survival (DFS) were evaluated. 197 patients (median age 60.7 years, 66.5% males, 52.8% oropharyngeal carcinomas) were analyzed. Complete resection (R0) was achieved in 85.8% of cases. Ipsilateral ND was performed in all patients and contralateral ND in 144 patients (73.1%). Concurrent chemotherapy was given to 59patients (30.0%). After amedian follow-up of 45.5 months, OS and DFS of all patients were 73.6% and 70.9% at 5years, respectively. Atotal of 45patients (22.8%) suffered from alocoregional recurrence, lymph node metastases of the contralateral neck developed in 12patients (6.1%) only. There was no significant difference in contralateral nodal failure rate with or without performance of contralateral ND. Regional failure of the contralateral neck was low after surgery and ipsilateral neck irradiation in head and neck carcinomas without midline extension, supporting evidence that contralateral neck radiotherapy can safely be omitted in selected cases.

Evaluation of Locoregional Recurrence Patterns Following Adjuvant (Chemo)Radiotherapy for Oral Cavity Carcinoma

AimsTo evaluate patterns of locoregional recurrence following adjuvant (chemo)radiotherapy for oral cavity squamous cell carcinomas. Materials and methodsOne hundred and one patients who received adjuvant radiotherapy ± chemotherapy for oral cavity squamous cell carcinoma between 2013 and 2016 were analysed. For documented locoregional recurrence, recurrence imaging was deformably co-registered to the planning computed tomography scan. The volume of recurrence was delineated (Vrec). Vrec coverage by 95% of the corresponding planning target volume prescription dose was determined and the location compared with planning target volumes. Sites of recurrence were classified using a combined volume and centroid-based method: (A) central high dose, (B) peripheral high dose, (C) central low dose, (D) central peripheral dose, (E) extraneous. ResultsThe median follow-up was 36 months. Forty-three per cent and 53% of patients received radiotherapy to the ipsilateral neck only and bilateral neck, respectively. Three-year overall survival, disease-free survival, local control, regional control and distant metastases-free survival were 63.0, 65.6, 88.0, 85.1 and 85.3%, respectively. Of 10 episodes of primary site recurrences, five were type A, four type B and one was type E. Of 14 episodes of regional recurrence, five were type A, two type C, two type D and five type E. Five of 21 (24%) patients with oral tongue carcinoma with an undissected/unirradiated contralateral neck had a type E contralateral neck recurrence, including 2/11 with pN0, 1/4 with pN1 and 2/6 with pN2 disease. ConclusionsMarginal and out-of-field recurrences remain a significant pattern of failure. We advocate generous target delineation postoperatively and, for oral tongue carcinomas, a comprehensive approach with bilateral neck irradiation.

Risk of post-operative, pre-radiotherapy contralateral neck recurrence in patients treated with surgery followed by adjuvant radiotherapy for human papilloma virus-associated tonsil cancer.

One approach to reduce treatment-related morbidity for human papilloma virus (HPV)-associated tonsil cancer is omitting radiotherapy to the contralateral neck. Pathologic risk factors for early contralateral neck disease, however, are poorly understood. We report on the risk contralateral neck failures from the time of pre-operative diagnostic imaging to time of planning for adjuvant radiation in a single institution series of HPV-associated tonsillar cancer patients undergoing surgery followed by radiotherapy (RT). Retrospective analysis of 123 patients with T1-T3 HPV-positive tonsillar squamous cell carcinoma treated between 2010 and 2016 with transoral robotic surgery and selective ipsilateral neck dissection followed by adjuvant RT. Contralateral neck recurrence was classified as the detection of a pathologic node in the contralateral neck prior to initiation of adjuvant RT. Seven patients (5.7%) developed contralateral neck disease/failure between the time of pre-operative diagnostic neck imaging and time of planning of adjuvant radiation. Increased ratio of positive/resected nodes [odds ratio (OR) 1.073, p = 0.005] was significantly associated with increased risk of contralateral neck recurrence, with a trend found for close/positive margins (OR 5.355, p = 0.06), tumor size (OR 2.046, p = 0.09), and total number of nodes positive (OR 1.179, p = 0.062). Patients who develop very early contralateral neck disease, between completion of ipsilateral neck dissection and the initiation of radiotherapy, have a higher ratio of positive nodes to total nodes resected in the ipsilateral neck. These findings suggest that proper selection of patients for omission of treatment of the contralateral, node-negative neck should be made with this in mind, with future studies needed to document the impact on toxicity and disease outcomes from such an approach. Pathologic risk factors in the dissected, ipsilateral neck in patients with tonsil cancer may inform the risk of contralateral neck failure. Patient selection for future, prospective efforts to examine sparing of the contralateral neck need to be based with these risk factors in mind.

Ipsilateral neck radiotherapy in N2b well-lateralized tonsil cancer - Approach with caution.

Treatment of the uninvolved neck in well-lateralized tonsillar squamous cell carcinoma is controversial. We became concerned after a number of contralateral neck recurrences (CNRs) in patients receiving ipsilateral radiotherapy (RT). This is a single center retrospective series including patients with well-lateralized tonsillar cancer treated with ipsilateral neck RT between 2004 and 2011. We identified 53 patients treated with ipsilateral neck RT during the study period. The rate of CNR was 7.5% (4 of 53). All four patients had p16-positive, T1, N2b, M0 tumors. The subgroup of patients with N2b disease (28 of 53) had a CNR of 14.3%. We subsequently switched to treat patients with N2b with bilateral neck RT. We analyzed the outcomes of 23 patients with N2b treated with bilateral neck intensity-modulated RT (IMRT) and observed no CNRs. We observed a higher than expected rate of CNR in the N2b population. Bilateral neck IMRT for these patients represents a safe alternative.

Challenging the Requirement to Treat the Contralateral Neck in Cases With >4 mm Tumor Thickness in Patients Receiving Postoperative Radiation Therapy for Squamous Cell Carcinoma of the Oral Tongue or Floor of Mouth.

While treating patients with postoperative radiotherapy (RT) for squamous cell carcinoma of the oral tongue or floor of mouth, we hypothesized a low risk of tumor recurrence in the contralateral neck in the absence of contralateral neck RT when the primary tumor is >1 cm from the midline regardless of tumor thickness (TT) or depth of invasion (DOI)>4 mm. The policy at our institution for many years has been to limit postoperative RT to the ipsilateral side when the primary tumor does not cross the midline, regardless of TT or DOI. We report the rate of isolated contralateral neck failure in this group. We retrospectively reviewed all patients treated with postoperative RT at our institution between 1998 and 2014 for pathologic stage T1-T4 N1-N2b squamous cell carcinoma of the oral tongue or floor of mouth that did not cross the midline and thus were treated with RT limited to the primary site +/- ipsilateral neck. Our study population included 32 patients: 75% with close (<5 mm) or positive margins and 38% with perineural invasion. No patients had a tumor that crossed the midline. TT was ≥4 mm in 75% of patients. DOI was >5 mm in 68% of patients. There were no isolated contralateral neck recurrences with a median follow-up of 5 years. While delivering postoperative RT for oral tongue or floor of mouth cancer with pathologic neck stage N0-2b, the risk of not irradiating the contralateral neck is very low when the primary tumor does not cross the midline, regardless of other factors at the primary site, such as TT and DOI.

Patterns of Failure and Clinical Outcomes of Post-operative Buccal Mucosa Cancers Treated with Ipsilateral Radiation Therapy

Loco-regional failure in carcinoma buccal mucosa (BM) after radical resection and adjuvant radiotherapy (RT) generally entails a bad prognosis. Usually, adjuvant RT (if indicated), is delivered to tumor bed and bilateral neck nodes. However, selected patients could be treated with ipsilateral RT to tumor bed and neck nodes (IL-RT). Literature on patterns of failure in this group of patients is sparse. We aimed to analyse the failure patterns and survival outcome in these cohort of patients treated at our institute. Eighty patients of post-operative BM cancers treated with IL-RT from June 2013 to May 2017 were included in this retrospective analysis. RT dose was 60-66 Gray in 30-33 fractions over 6-6.5 weeks delivered by linear accelerator using 3-dimensional conformal radiotherapy techniques. All outcomes were evaluated from the time of registration. Local, regional and loco-regional control was defined as time from registration to failure in tumor bed, regional nodes or both, respectively. Disease free survival (DFS) and overall survival (OS) were defined as time from registration to failure at any site (local, regional or distant) and death from any cause, respectively. Kaplan Meier method was used for all outcome analysis. The median age was 45.5 years (range 30-80). Patient characteristics are described in table 1. Median RT completion time and the overall treatment time were 6.2 weeks (range 5.9-7.1) and 11.6 weeks (range 8.5-19), respectively. 62 patients received 60 Gy, one patient 64 Gy and the rest received 66 Gy. The median follow-up time was 24.4 months (range 5-54.2).The 2-year local, regional and loco-regional control rates were 91.9%, 87.6% and 80.5%, respectively. The 2-year DFS and 2-year OS rates were 76.4% and 82.8%, respectively. The crude rates of failures at primary site, ipsilateral and contralateral neck were 12.5%, 12.5% and 3.7%, respectively. All patients with contralateral neck recurrence had N2 disease. Five patients (6.25%) had distant failures. Sixteen patients (20%) died of cancer and 2 patients died of non-malignant causes. The incidence of contralateral recurrence in BM cancer patients treated with primary surgery and adjuvant IL-RT is low. BM cancer with 1-3 risk factors may be treated with IL-RT, except, patients with N2 nodal status, who are at higher risk of contralateral regional recurrence.Abstract MO_23_2678; Table 1Patient CharacteristicsDistributionGender (Male: Female)75: 5T stage (T1: T2: T3: T4)10%: 43%: 26%: 21%N stage (N0: N1: N2)63%: 19%: 18%Overall TNM stage (I: II: III: IV) (As per AJCC 7th edition)5%: 30%: 23%: 42%Risk factors for post-operative RT (>pT3: pN+: PNI: LVI: Close margins: Tumor thickness)*52: 40: 18: 24: 13: 55Number of risk factors for post-op RT (1: 2: 3: >4)10%: 60%: 17.5%: 12.5%Grade (1: 2: 3)42: 34: 4*The total may not add up to 100% because of presence of multiple factors. Abbreviations: RT=Radiotherapy; PNI=Peri-neural invasion; LVI=Lympho-vascular invasion Open table in a new tab

Challenging the Requirement to Treat the Contralateral Neck with >4-Mm Tumor Thickness in Patients Receiving Postoperative Radiation Therapy for Squamous Cell Carcinoma of the Oral Tongue or Floor of Mouth

In patients with oral tongue or floor of mouth squamous cell carcinoma (SCC), the policy at our institution for many years has been to limit postoperative radiotherapy (RT) to the ipsilateral side when the primary tumor does not cross the midline, regardless of tumor thickness or depth of tumor invasion. We report the rate of contralateral neck failure in this group. We retrospectively reviewed the medical records of patients with T1-4 N1-N2b SCC of the oral tongue or floor of mouth who underwent postoperative RT to the primary site +/− ipsilateral neck RT between 1998 and 2014. No patients received radiation to the contralateral neck. All patients received resection of the primary site with or without ipsilateral and/or bilateral neck dissection. Our study population was 32 patients: 75% with close (<5 mm) or positive margins; 38% with perineural invasion. No patient had a tumor that crossed the midline. Tumor thickness was ≥4 mm in 75% of patients. Depth of invasion was >5 mm in 68% of patients. The rate of isolated contralateral neck recurrence was 3% (1/32). When delivering postoperative RT for oral tongue or floor of mouth cancer, the risk of not irradiating the contralateral neck is very low when the primary tumor does not cross the midline, regardless of other factors at the primary site, including tumor thickness and depth of invasion.

Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience

BackgroundThe patterns of nodal relapse in submandibular gland carcinoma (SMGC) patients treated with postoperative radiotherapy (PORT) remain unclear. This study aims to investigate the nodal failure patterns and the utility of elective nodal irradiation (ENI) in SMGC patients undergoing PORT.MethodsWe retrospectively enrolled 65 SMGC patients who underwent PORT between 2000 and 2014. The nodal failure sites in relation to irradiation fields and pathological parameters were analyzed. ENI regions were categorized into three bilateral echelons (first, levels I–II; second, level III; and third, levels IV–V). Extended ENI was defined as coverage of at least the immediately adjacent uninvolved echelons bilaterally; otherwise, limited ENI was administered.ResultsThirty patients (46%) were stage III–IV, and 18 (28%) were pN+. Neck irradiation included limited (72%) and extended ENI (28%). With a median follow-up of 79 months, 11 patients (17%) developed nodal failures (ipsilateral, N = 6; contralateral, N = 7), 7 (64%) of whom relapsed in the adjacent uninvolved echelons. We identified pN+ (P = 0.030), extranodal extension (ENE, P = 0.002), pT3–4 (P = 0.021), and lymphovascular invasion (LVI, P = 0.004) as significant predictors of contralateral neck recurrence. Extended ENI significantly improved regional control (RC) in patients with pN+ (P = 0.003), ENE (P = 0.022), pT3–4 (P = 0.044), and LVI (P = 0.014), and improved disease-free survival (DFS) in patients with pN+ (P = 0.034). For patients with ≥2 coincident adverse factors, extended ENI significantly increased RC (P < 0.001), distant metastasis-free survival (P = 0.019), and DFS (P = 0.007); conversely, no nodal recurrence was observed in patients without these adverse factors, even when only the involved echelon was irradiated.ConclusionsNodal failure is not uncommon in SMGC patients treated with PORT if pN+, ENE, pT3–4, and LVI are present. Extended ENI should be considered, particularly in patients with multiple pathological adverse factors.

Comparison of the Clinical Outcomes of Patients with Squamous Cell Carcinoma of the Tonsil Receiving Postoperative Ipsilateral Versus Bilateral Neck Radiotherapy: A Propensity Score Matching Analysis (KROG 11-07).

PurposeThe impact of postoperative ipsilateral neck radiotherapy (INRT) versus bilateral neck radiotherapy (BNRT) on the clinical outcomes of patients with tonsillar squamous cell carcinoma was analyzed retrospectively.Materials and MethodsBetween October 2001 and June 2012, 241 patients with T1-2 and N0-N2b tonsillar carcinoma from 16 institutes underwent postoperative INRT (n=84) or BNRT (n=157) following a tonsillectomy. Seventy patients were identified from each group by propensity score matching and compared in terms of the overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates calculated using the Kaplan-Meier method with a log-rank test.ResultsThe median follow-up was 55 months (range, 3 to 133 months). The survival outcomes in the INRT and BNRT groups were similar: 5-year OS (92.8% vs. 94.0%, p=0.985), DFS (80.5% vs. 94.2%. p=0.085), LRRFS (88.1% vs. 97.1%, p=0.083), and DMFS (92.7% vs. 97.0%, p=0.370). Subgroup analysis revealed no contralateral neck recurrence in 61 patients with T1-2N0-2a regardless of the treatment groups. For 79 patients with N2b, contralateral neck recurrence was more common in the INRT group than in the BNRT group (7.9% vs. 0.0%), but the difference was not significant (p=0.107). The overall grade ≥ 2 toxicities were lower in the INRT group: acute (45.7% vs. 74.3%, p=0.001) and late (4.3% vs. 31.4%, p < 0.001), respectively.ConclusionINRT is an attractive strategy for patients with T1-2N0-2a tonsillar carcinoma compared to BNRT. For patients with N2b, there was a small risk of contralateral neck recurrence when treated with INRT, but its impact on the OS was limited with successful salvage treatment.

Unilateral radiotherapy for surgically resected lateralized squamous cell carcinoma of the tonsil.

The purpose of this study was to determine the rate of contralateral neck recurrence after surgery and unilateral neck radiotherapy, for lateralized tonsillar cancers with ipsilateral neck disease, in order to inform future clinical trial protocols for this disease. Patients with lateralized tonsillar squamous carcinoma (T1-T2, N0-N2b), treated with surgery and unilateral adjuvant radiotherapy in a single United Kingdom center were retrospectively identified. Rates of recurrence in the contralateral, unirradiated neck were analyzed, together with survival and toxicity data. Of 81 patients included, after a median follow-up of 5.7 years, no contralateral recurrences were identified. Five-year overall survival, progression-free survival, and locoregional control were 91.0%, 93.0%, and 95.4%, respectively. Unilateral radiotherapy is an effective and safe treatment option for the postoperative management of lateralized tonsillar cancers, even in patients with N2b disease, and should be recommended in future clinical trial protocols. © 2016 Wiley Periodicals, Inc. Head Neck 39: 17-23, 2017.

Contralateral neck failure in lateralized oral squamous cell carcinoma.

Elective treatment of the contralateral clinically node-negative (cN0) neck is not routinely recommended for lateralized oral cavity squamous cell carcinoma (SCC). We sought to determine the failure rate in the untreated contralateral neck in patients with lateralized oral SCC undergoing treatment of the primary and ipsilateral neck and to identify any features placing patients at sufficient risk of contralateral regional failure to justify elective treatment. We identified 688 patients with oral SCC undergoing curative surgery ± adjuvant therapy between 1985 and 2012 from a prospectively collected database. Patients with midline primaries and those undergoing bilateral neck treatment were excluded. The primary endpoint was isolated contralateral neck failure. Of 481 patients, 14 (2.9%) developed isolated contralateral neck recurrence, with median time to recurrence of 8 months. Patients with poorly differentiated tumours or pathologically proven ipsilateral nodal metastases were at significantly higher risk of contralateral failure (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.1-11.9, P = 0.037 and HR 4.6, 95% CI 1.5-13.8, P = 0.006 respectively). Presence of both of these factors conferred a 10% risk of contralateral failure. Patients with lateralized oral SCC undergoing treatment of the primary tumour and ipsilateral neck have a low rate of isolated contralateral neck failure. Although poorly differentiated primaries and ipsilateral nodal metastases were predictors of contralateral recurrence, the risk remains relatively modest in this subset of patients suggesting close observation may be more appropriate than elective treatment. Our results support current recommendations for observation of the cN0 contralateral neck in lateralized oral SCC.

The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis

Conclusion: The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. Objectives: Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. Methods: This was a retrospective cohort, chart review involving 305 surgically treated patients with T1–3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as ‘no,’ ‘<5 mm’ or ‘≥5 mm.’ Results: The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.

Risk factors and treatment of contralateral neck recurrence for unilateral oral squamous cell carcinoma: A retrospective study of 1482 cases

The aim of this study was to describe risk factors of contralateral neck recurrence (CLNR) and to identify its high-risk population after treatment for unilateral oral squamous cell carcinoma. Between June 1991 and June 2012, a total of 1482 eligible patients who were treated with radical surgery with or without adjuvant therapy were retrospectively reviewed. The outcome assessment parameters were the rate of 5-year CLNR and the rate of disease-specific survival (DSS). In the entire study cohort, the 5-year CLNR rate was 4.1%. In a multivariate analysis, only extracapsular spread (ECS) status (hazard ratio [HR]: 12.978, 95% confidence interval [CI]: 1.328-126.829, P=0.028) was an independent risk factor for 5-year CLNR. In addition, 5-year CLNR (HR: 36.410, 95% CI: 7.093-186.914, P<0.001), T stage (HR: 3.475, 95% CI: 1.151-10.488, P=0.027) and growth pattern (HR: 4.831, 95% CI: 1.776-13.140, P=0.002) were independent risk factors for 5-year DSS. Patients with at least two risk factors were identified as a high-risk population for CLNR; these patients also had a poor prognosis. Elective contralateral neck dissection (ND) plus concurrent chemoradiotherapy (CCRT) can improve the 5-year DSS in these high-risk patients, but it does not decrease the 5-year CLNR rate. For low- and moderate-risk patients, contralateral neck observation should be considered sufficient if strict compliance with a cancer surveillance protocol is followed. However, whether high-risk patients benefit from contralateral ND plus adjuvant CCRT can only be answered in a prospective trial.