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    Characterizing Lymph Node Burden With Elective Unilateral Neck Irradiation in Human Papillomavirus-Positive Tonsil Squamous Cell Carcinoma: Defining the Upper Limits.

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    Author
    Hara, Jared H
    Gutiontov, Stanley I
    Uddin, Sophia
    Rosenberg, Ari J
    Pearson, Alexander T
    Gooi, Zhen
    Blair, Elizabeth A
    Agrawal, Nishant
    Vokes, Everett E
    Ginat, Daniel T
    Haraf, Daniel J
    Juloori, Aditya
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    Date
    2022-07-31
    Journal
    Cureus
    Publisher
    Cureus, Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.7759/cureus.27521
    Abstract
    Objectives Elective unilateral neck irradiation in well-lateralized tonsil carcinoma for N2b disease is controversial. Metrics regarding nodal burden beyond the N-stage to define the upper limit of this de-escalation approach remain limited. We investigated the role of nodal number, level, and volume on outcomes in patients with well-lateralized tonsil carcinoma treated with this approach. Methods A total of 37 patients received radiotherapy (RT) with unilateral neck coverage for well-lateralized tonsil cancer. Of patients, 95% had p16+ disease, and 81% were staged with positron emission tomography/computed tomography. The majority of patients received definitive chemoradiation on prospective de-escalation trials. Ten patients had ipsilateral neck dissections and were treated adjuvantly. The median RT dose to the ipsilateral neck (generally II-IV) was 45 Gy. The effects of nodal number, max dimension, volume, and level on recurrence-free survival (RFS) and overall survival (OS) were to be analyzed via Cox proportional hazards (Cox-PH). Results After a median follow-up of 3.9 years, two-year RFS and two-year OS were 100% and 97%, respectively. Given the 0% contralateral recurrence rate, Cox-PH analysis was not performed. Of patients, 70% were American Joint Committee on Cancer (AJCC) 7th edition N2b, with a median number of nodes, number of nodal levels, max dimension, and volume of two, one, 3.4 cm, and 15.6 cc, respectively. There were several patients with low-lying nodes; aggregate nodal volume measured was up to 85.4 cc. Conclusion Unilateral neck irradiation in well-lateralized tonsil carcinoma resulted in no contralateral recurrence. Nodal volume, level, and number do not seem to have a significant impact on outcomes.
    Rights/Terms
    Copyright © 2022, Hara et al.
    Keyword
    head and neck squamous cell cancer
    hpv-related oropharyngeal cancer
    human papilloma virus
    intensity-modulated radiotherapy
    ipsilateral neck radiation
    oral and oropharyngeal cancer
    quality of life
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/19677
    ae974a485f413a2113503eed53cd6c53
    10.7759/cureus.27521
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