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dc.contributor.authorHara, Jared H
dc.contributor.authorGutiontov, Stanley I
dc.contributor.authorUddin, Sophia
dc.contributor.authorRosenberg, Ari J
dc.contributor.authorPearson, Alexander T
dc.contributor.authorGooi, Zhen
dc.contributor.authorBlair, Elizabeth A
dc.contributor.authorAgrawal, Nishant
dc.contributor.authorVokes, Everett E
dc.contributor.authorGinat, Daniel T
dc.contributor.authorHaraf, Daniel J
dc.contributor.authorJuloori, Aditya
dc.date.accessioned2022-09-07T13:20:51Z
dc.date.available2022-09-07T13:20:51Z
dc.date.issued2022-07-31
dc.identifier.urihttp://hdl.handle.net/10713/19677
dc.description.abstractObjectives 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.en_US
dc.description.urihttps://doi.org/10.7759/cureus.27521en_US
dc.language.isoenen_US
dc.publisherCureus, Inc.en_US
dc.relation.ispartofCureusen_US
dc.rightsCopyright © 2022, Hara et al.en_US
dc.subjecthead and neck squamous cell canceren_US
dc.subjecthpv-related oropharyngeal canceren_US
dc.subjecthuman papilloma virusen_US
dc.subjectintensity-modulated radiotherapyen_US
dc.subjectipsilateral neck radiationen_US
dc.subjectoral and oropharyngeal canceren_US
dc.subjectquality of lifeen_US
dc.titleCharacterizing Lymph Node Burden With Elective Unilateral Neck Irradiation in Human Papillomavirus-Positive Tonsil Squamous Cell Carcinoma: Defining the Upper Limits.en_US
dc.typeArticleen_US
dc.identifier.doi10.7759/cureus.27521
dc.identifier.pmid36060366
dc.source.journaltitleCureus
dc.source.volume14
dc.source.issue7
dc.source.beginpagee27521
dc.source.endpage
dc.source.countryUnited States


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