Contralateral neck failure in oral tongue cancer: Outcomes from two centers using predefined treatment criteria

Abstract

Background The objective was to determine the incidence of, and factors associated with contralateral neck failure (CNF) in oral tongue squamous cell carcinoma (OTSCC). Methods Consecutive patients with OTSCC between 2007 and 2016 were included. The predefined policy of the contralateral neck included neck dissection (ND) where the primary tumor extended/crossed midline or the contralateral neck was involved; and elective nodal irradiation (ENI) where the primary tumor was ≤1 cm from midline/2 cm from tip. Results This study included 258 patients. ND was ipsilateral 169 (66%) and bilateral 33 (13%). Fifty‐five patients (21%) received ENI to the undissected contralateral neck. CNF occurred in 19 patients (7%) and was similar by treatment received. Utilizing this approach, we observed higher rates of CNF with increasing N classification, perineural invasion, extracapsular extension, and depth of invasion ≥6 mm. Conclusions Using our institutional policy of treatment to the contralateral neck, a low rate of CNF (≤10%) was observed.

A Rational Approach to Unilateral Neck RT for Head and Neck Cancers in the Era of Immunotherapy

“…In order to determine the incidence of and factors associated with contralateral neck failure, Udovicich et al examined the clinical outcomes of patients with oral tongue squamous cell carcinoma treated with a predefined policy contralateral neck radiotherapy between 2007 and 2016 at two Australian centers [ 96 ]. Their policy involved performing contralateral neck dissection (ND) when the primary tumor crossed the midline and recommending bilateral elective nodal irradiation (ENI) when the primary tumor was ≤1 cm from the midline or 2 cm from the tip of the tongue [ 96 ]. Of the 258 patients in the study, ND was ipsilateral in 169 (66%) and bilateral in 33 (13%), and 55 patients (21%) received ENI to the undissected contralateral neck [ 96 ].…”

“…Their policy involved performing contralateral neck dissection (ND) when the primary tumor crossed the midline and recommending bilateral elective nodal irradiation (ENI) when the primary tumor was ≤1 cm from the midline or 2 cm from the tip of the tongue [ 96 ]. Of the 258 patients in the study, ND was ipsilateral in 169 (66%) and bilateral in 33 (13%), and 55 patients (21%) received ENI to the undissected contralateral neck [ 96 ]. There were 51 patients treated with ipsilateral neck dissection and ipsilateral neck RT.…”

“…There were 51 patients treated with ipsilateral neck dissection and ipsilateral neck RT. With this approach, contralateral neck failure occurred in 19 patients (7%) and was similar by treatment group, but salvage was poor after recurrence (15/19 died of cancer) [ 96 ]. Factors associated with increased contralateral neck failures included increasing nodal stage, perineural invasion, extracapsular extension, and depth of invasion ≥6 mm [ 96 ].…”

“…With this approach, contralateral neck failure occurred in 19 patients (7%) and was similar by treatment group, but salvage was poor after recurrence (15/19 died of cancer) [ 96 ]. Factors associated with increased contralateral neck failures included increasing nodal stage, perineural invasion, extracapsular extension, and depth of invasion ≥6 mm [ 96 ]. In the ongoing NRG-HN006 trial comparing sentinel lymph node biopsy with standard neck dissection for patients with early-stage oral cavity cancer, unilateral RT is allowed for patients with AJCC 8th pT1-4, pN0-2b disease, as long as the primary tumors are lateralized (≥1 cm from the midline) [ 97 ].…”

Dosimetric Comparison of Intensity-Modulated Radiation Therapy (IMRT) and Intensity-Modulated Proton Therapy (IMPT) for a Novel Oral Tongue Avoidance Concept in Low-Risk Squamous Cell Carcinoma of the Oral Tongue

“…Adjuvant radiation therapy typically targets the entire oral tongue, bilateral elective neck levels, and in-transit lymphatics due to the risk of skip metastases. For tumors with significant DOI or clinically positive ipsilateral neck disease, the contralateral neck can remain at risk of nodal failure even in lateralized tumors [ 4 , 5 ]. While considered the standard of care, intentional irradiation of the oral tongue can be particularly toxic and result in acute and late toxicities, including confluent mucositis, persistent dysgeusia, swallowing dysfunction, speech alteration, osteoradionecrosis, and dental caries [ 6 ].…”