Incidence of contralateral-bilateral nodes in the human papillomavirus era

Tritter, Andrew G.; Mehta, Vikas; Samuelson, Madeleine; deGravelle, Ginger; Ma, Xuexiao; Medlin-Moore, Tara; Takalkar, Amol; Caldito, Gloria; Nathan, Cherie Ann O.

doi:10.1002/lary.26439

Cited by 20 publications

(30 citation statements)

References 23 publications

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“…It was also expected that tumor subsite independently predicted contralateral or bilateral nodal disease with BOT tumors resulting in over 2‐times the odds to tumors originating at the tonsil complex (OR 2.15). These findings are consistent with prior studies …”

Section: Discussionsupporting

confidence: 94%

“…Transposing this comparison, in the presence of contralateral or bilateral nodal disease, nonsignificant differences in survival were observed by subsite when HPV‐positive and negative cohorts were examined separately (Table ). These results are consistent with data reported by Tritter et al who revealed no difference. When considering changes implemented by the eighth edition of the AJCC staging system, ENE status was utilized to stratify HPV‐negative cases into two subcohorts.…”

Section: Discussionsupporting

confidence: 94%

“…In this sample, overall contralateral or bilateral nodal disease rates were notably decreased in magnitude compared to prior nondatabase studies at 14.2% and 14.5% for HPV‐positive and HPV‐negative groups, respectively ( P = .715). This distribution does reflect other database studies conducted with the NCDB and Surveillance Epidemiology and End Results, which may be more appropriate for comparison .…”

Section: Discussioncontrasting

confidence: 57%

“…This study's findings are questionable, however, given its limited sample size (N = 41) and lack of improved survival in the HPV‐positive cohort. More recently, Tritter et al conducted a larger study (N = 178), and reported a nonsignificant difference in overall contralateral or bilateral nodal disease rates between HPV‐positive and HPV‐negative cases (24.6% vs 29.1%; P = .53). Although the study identified other known predictors, including midline tumor location and T4 classification, a rigorous analysis controlling for multiple critical features was not used; this may have served as its largest limitation in identifying differences in rates between HPV‐positive and negative cases.…”

Section: Discussionmentioning

confidence: 99%

“…When considering rate distributions by subsite within HPV‐positive and negative cohorts, its clinical significance is most evident in contralateral or bilateral nodal disease rates of HPV‐positive BOT tumors. Therefore, it seems that HPV‐positive midline tumors bear the highest likelihood for advanced nodal metastasis regardless of tumor classification, which is often cited as a significant confounder of contralateral or bilateral nodal disease . These lesions may warrant higher suspicion for contralateral nodal metastasis when considering the management of the neck.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of contralateral‐bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

et al. 2017

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of contralateral‐bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

et al. 2017

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Risk and Rate of Occult Contralateral Nodal Disease in Surgically Treated Patients With Human Papillomavirus−Related Squamous Cell Carcinoma of the Base of the Tongue

Pipkorn

Chen

Kallogjeri

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThe optimal treatment strategy for patients with human papillomavirus (HPV)−related oropharyngeal squamous cell carcinoma (OPSCC) of the base of the tongue (BOT) has not been sufficiently studied.OBJECTIVE To investigate the rate of and risk factors for occult contralateral nodal disease in patients with HPV-related BOT OPSCC undergoing transoral surgery and bilateral neck dissections. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case series reviewed the medical records of patients with HPV-related BOT OPSCC who underwent transoral surgery and bilateral neck dissections from January 1, 2002, through December 31, 2018, at the tertiary care center of Washington University School of Medicine in St Louis. Patients had a median follow-up of 30.0 months (interquartile range, 11.0-60.4 months). Patients with recurrent disease or multiple synchronous OPSCC primary tumors were excluded for a total of 89 patients. Data were analyzed from January 1 through June 1, 2019. MAIN OUTCOMES AND MEASURESThe primary outcome was the rate of contralateral occult nodal disease. Secondary outcomes were potential risk factors for contralateral occult nodal disease and regional recurrence rates.RESULTS Eighty-nine patients were included in the series, of whom 81 (91.0%) were men. The mean (SD) age was 60 (9) years. Overall, 34 patients (38.2%) had pathologic contralateral nodal metastases. Seventy patients had no clinical evidence of contralateral nodal disease. Of these 70, occult nodes were identified in 15 (21.4%). Risk of contralateral disease was higher when the primary tumor crossed midline (odds ratio, 6.23; 95% CI, 1.71-22.77). Of the 55 patients with no occult disease identified, only 2 (3.6%) received radiotherapy to the contralateral neck, and no regional recurrence of disease was noted.CONCLUSIONS AND RELEVANCE Given the rate of occult contralateral nodal disease of 21.4%, it appears that contralateral elective neck dissection or radiotherapy should be recommended in patients with HPV-related BOT OPSCC. Patients with a pathologically negative result of contralateral neck dissection may not benefit from radiotherapy to that nodal basin. Future prospective investigations should evaluate functional and oncologic outcomes of contralateral elective neck dissection compared with elective radiotherapy in the contralateral neck for HPV-related BOT OPSCC.

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Ipsilateral neck radiotherapy in N2b well‐lateralized tonsil cancer – Approach with caution

et al. 2019

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Background 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). Methods This is a single center retrospective series including patients with well‐lateralized tonsillar cancer treated with ipsilateral neck RT between 2004 and 2011. Results 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. Conclusions We observed a higher than expected rate of CNR in the N2b population. Bilateral neck IMRT for these patients represents a safe alternative.

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Incidence of contralateral-bilateral nodes in the human papillomavirus era

Abstract: 4 Laryngoscope, 127:1328-1333, 2017.

Cited by 20 publications

References 23 publications

Predictors of contralateral‐bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Predictors of contralateral‐bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Risk and Rate of Occult Contralateral Nodal Disease in Surgically Treated Patients With Human Papillomavirus−Related Squamous Cell Carcinoma of the Base of the Tongue

Ipsilateral neck radiotherapy in N2b well‐lateralized tonsil cancer – Approach with caution

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