Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: Updated results of an institutional clinical management approach

Dan, Tu; Raben, David; Schneider, Charles J.; Hockstein, Neil; Witt, Robert L.; Dzeda, Michael; Cormier, Jennifer F.; Raben, Adam

doi:10.1016/j.oraloncology.2015.03.013

Cited by 26 publications

(34 citation statements)

References 28 publications

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“…Moreover, approximately 10% of patients receiving BNRT experienced grade 2 dysphagia, whereas none of the patients undergoing INRT did. The 3% rate of xerostomia in this population was modestly superior to that of the 8% reported by Dan et al [ 18 ] who published the outcomes of INRT for node-positive tonsil cancer with a median follow-up of 37.2 months. IMRT is an advantageous option to reduce xerostomia when treating head and neck cancer because it facilitates the delivery of lower radiation doses to the parotid gland.…”

Section: Discussioncontrasting

confidence: 57%

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)

et al. 2017

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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.

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Section: Discussioncontrasting

confidence: 57%

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)

et al. 2017

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“…27 Dan et al reported the results of patients treated with unilateral RT in a community setting including 31 patients with N2b disease, and observed 1 contralateral recurrence in this group. 28 Several other studies also reported no contralateral recurrences. 10,29 In contrast, other studies have reported modest recurrence rates after unilateral RT for the treatment of patients with palatine tonsil squamous cell carcinoma.…”

Section: Discussionmentioning

confidence: 90%

“…Ye et al also reported no recurrences among 11 patients with well‐lateralized tonsillar cancer with N2b disease who were treated with unilateral RT . Dan et al reported the results of patients treated with unilateral RT in a community setting including 31 patients with N2b disease, and observed 1 contralateral recurrence in this group . Several other studies also reported no contralateral recurrences …”

Section: Discussionmentioning

confidence: 91%

Comparison of unilateral versus bilateral intensity‐modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil

Chin

Rao

Hwang

et al. 2017

Cancer

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“…Radiation to the neck in OPSCC is generally performed bilaterally, except in cases of very well‐lateralized tonsillar fossa cancer . Given the low incidence of contralateral regional failures, there is speculation that bilateral neck irradiation may be an overtreatment in a large portion of OPSCC patients . Thus, in patients with pathologically negative disease on neck dissection, sparing the toxicities of radiation to the contralateral neck may help elucidate a unique beneficial role of surgery even in those receiving trimodality care.…”

Section: Introductionmentioning

confidence: 99%

Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit?

et al. 2019

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Background With increasing adoption of transoral robotic surgery (TORS) for oropharyngeal cancer (OPC), more patients may receive trimodality therapy. We sought to investigate outcomes and toxicities in this cohort. Methods A retrospective study of patients with OPC treated with trimodality therapy at a tertiary‐care hospital, comparing those receiving bilateral vs unilateral neck radiation. Results Four hundred thirty‐six patients underwent TORS, 17% receiving adjuvant chemoradiation. Of the 46 patients completing adjuvant treatment in‐house, contralateral neck was spared in 20%. There were no significant differences in survival, and patient‐reported outcomes in salivary function, mood, and anxiety were superior in those patients receiving unilateral neck radiation and directly correlated with mean dose to local structures. Conclusions Surgery for OPC offers the potential for reduction in radiation volumes by omitting the contralateral neck in those who may have required definitive chemoradiation. Even in patients receiving concurrent chemotherapy, unilateral neck radiation has a favorable toxicity profile without compromising survival.

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Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: Updated results of an institutional clinical management approach

Cited by 26 publications

References 28 publications

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)

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)

Comparison of unilateral versus bilateral intensity‐modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil

Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit?

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