Contralateral regional recurrence after elective unilateral neck irradiation in oropharyngeal carcinoma: A literature-based critical review

Al‐Mamgani, Abrahim; Werkhoven, Erik van; Navran, Arash; Karakullukcu, Bariş; Hamming‐Vrieze, Olga; Machiels, Mélanie; Velden, Lilly–Ann van der; Vogel, Wouter V.; Klop, W. Martin C.

doi:10.1016/j.ctrv.2017.07.004

Cited by 50 publications

(53 citation statements)

References 37 publications

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“…The available literature suggests a low CNF rate with URT in N2b disease (approximating 5%) and a lower unsalvageable rate of patients who truly experience an isolated CNF ( Table 5). A contemporary systematic review of URT outcomes reported a CNF rate of 1.47% (9/325), 4.15% (11/265) and 4.84% (9/186) in N0, N1 and N2b disease, respectively [22]. While these series reported ''N2b" outcomes, it is possible that the majority of included cases consisted of reasonably low volume N2b disease.…”

Section: Discussionmentioning

confidence: 95%

Patient-reported quality of life and toxicity in unilateral and bilateral radiotherapy for early-stage human papillomavirus associated tonsillar carcinoma

McDowell

Casswell

Bressel

et al. 2020

Clinical and Translational Radiation Oncology

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a b s t r a c tPurpose: The purpose of this study was to compare self-reported health-related quality of life (QoL) and symptom burden in early stage tonsillar carcinoma patients treated with unilateral (URT) and bilateral radiotherapy (BRT). Methods and materials: This is a secondary analysis of a larger study assessing patient reported outcomes in human papillomavirus (HPV) oropharyngeal cancer (OPC) patients. Recruited patients were !12 months from completion of radiotherapy. This analysis included only patients with T1-2, N1-2b tonsil cancer and excluded patients with base of tongue involvement or recurrent disease. QoL and patient reported toxicity was measured using the EORTC QLQ-C30 module and the MDASI-HN. Results: Patients were enrolled from November 2018 to May 2019. Of the 136 patients recruited to the main study, 43 were eligible for this substudy (22 URT, 21 BRT), with a median age and follow up of 58.2 and 3.0 years respectively. The two groups were balanced with respect to patient, tumor and treatment factors with the exception of higher rates of T2 disease (27% v 71%, p = 0.006) and more extensive GTV nodal volumes (11.0 v 25.5cc, p = 0.006) in the BRT group.BRT patients had lower global health status/QoL (84 v 69, p = 0.0005) and social functioning scores (93 vs 78, p = 0.033) on the EORTC QLQ-C30, and higher symptom severity (0.6 vs. 2.0, p = 0.001) and symptom interference scores (0.8 vs. 2.0, p = 0.010) on the MDASI-HN. Four of the six largest differences observed on MDASI-HN items were attributable to radiotherapy technique (dry mouth, mucous, difficulty swallowing/chewing and taste), with corresponding dose differences to the respective organs (contralateral parotid, oral cavity and pharyngeal constrictors). In every instance, severity of symptoms was worse on average for patients treated with BRT. Conclusions: In the highly conformal radiotherapy era, BRT in early HPV tonsillar cancer survivors has an enduring impact on long-term QoL and toxicity. Crown

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Section: Discussionmentioning

confidence: 95%

Patient-reported quality of life and toxicity in unilateral and bilateral radiotherapy for early-stage human papillomavirus associated tonsillar carcinoma

McDowell

Casswell

Bressel

et al. 2020

Clinical and Translational Radiation Oncology

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“…16,[34][35][36] The presence of lymphatic metastases may result in lymphatic re-routing that would predispose patients with lateralized tumors to contralateral metastases. This finding suggests that radiotracer migration can only be achieved in a lymph node with some normal architecture and not ones replaced entirely by metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is corroborated by data from the radiation literature suggesting that patients with involved lymph nodes are more likely to have contralateral neck involvement. 16,[34][35][36] The presence of lymphatic metastases may result in lymphatic re-routing that would predispose patients with lateralized tumors to contralateral metastases.…”

Section: Discussionmentioning

confidence: 99%

“…6 The morbidities of elective neck treatment can be significant. [13][14][15][16][17] Despite data demonstrating relatively low rates of contralateral disease, many patients with lateralized OPSCC receive bilateral neck treatment in the absence of clinical contralateral disease. [7][8][9] In addition, patients can suffer shoulder impairment that impacts their quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] Similarly, bilateral neck irradiation is associated with greater acute and late toxicities including xerostomia, dysphagia, fibrosis, and trismus with low rates of contralateral nodal failure and no difference in oncologic outcomes in appropriately selected cases. [13][14][15][16][17] Despite data demonstrating relatively low rates of contralateral disease, many patients with lateralized OPSCC receive bilateral neck treatment in the absence of clinical contralateral disease.…”

Section: Introductionmentioning

confidence: 99%

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Lymphatic mapping with SPECT‐CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

et al. 2019

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Background: Risk of contralateral nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) is currently based on clinical risk factors. We propose lymphatic mapping with single photon emission computed tomography (SPECT-CT) for tumor-specific delineation of lymphatic drainage to guide treatment.Methods: Retrospective review of lymphatic drainage patterns in cT1-2 OPSCC and contralateral cN0 neck with a nonoperative, awake injection of 99 m-Tc sulfur colloid and SPECT-CT. Results: Ten patients were reviewed. Primary sites included tonsil (n = 8, 80%) and tongue base (n = 2, 20%). All patients tolerated awake injections with no complications. Nine patients (90%) demonstrated satisfactory migration of radiotracer to neck node(s) with seven (78%) to the ipsilateral lateral neck, one (11%) to the ipsilateral lateral neck and retropharynx, and one (11%) to bilateral lateral neck nodes.Conclusions: Characterization of lymphatic drainage in OPSCC is feasible using a nonoperative injection technique and SPECT-CT. Drainage to the contralateral neck is rare, warranting further study to tailor treatment appropriately. K E Y W O R D Sawake injection, lymphoscintigraphy, neck dissection, oropharyngeal squamous cell carcinoma, sentinel lymph node biopsy, SPECT-CT, transoral robotic surgery

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Long‐term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study

Dou

Zhang

et al. 2020

Cancer Medicine

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Objective Controversy still exists regarding the volume of radiation for head and neck cancer of unknown primary (HNCUP). Theoretically, elective mucosal irradiation (EMI) should achieve a balance between survival and toxicity. This prospective study was conducted to evaluate the long‐term benefit of EMI in Chinese HNCUP patients. Methods A phase II, single‐arm trial was performed at two centers in China. HNCUP patients with pathologically confirmed metastatic squamous cell carcinoma or poorly differentiated carcinoma were enrolled. Patients with metastatic lymph nodes limited to level IV and/or the supraclavicular fossa were excluded. The EMI approach was specifically customized to Chinese patients by differentiating HNCUP as putative nasopharyngeal carcinoma (NPC) or non‐putative NPC. The primary endpoint was 3‐year mucosal recurrence‐free survival (MRFS). Results A total of 48 patients were enrolled between 02/02/2010 and 08/01/2018; 46 patients were analyzed, including 24 putative NPC and 22 non‐putative NPC patients. No primary recurrence was observed during a median follow‐up period of 70 months, and only 1 patient experienced out of field recurrence in the contralateral neck. The 3‐year MRFS was 90.6% (95%CI: 76.4%‐96.4%). The 5‐year MRFS, regional‐recurrence free survival (RRFS) and overall survival (OS) were 90.6% (95%CI: 76.4%‐96.4%), 86.0% (95%CI: 71.1%‐93.7%), and 90.6% (95%CI: 76.4%‐96.4%), respectively. No grade 4 acute or late toxicities occurred, and the most frequent grade 3 acute toxicity was oral mucositis (45.7%). Conclusion To the best of our knowledge, this is the first prospective study to evaluate the long‐term outcomes of EMI in Chinese HNCUP patients. Excellent MRFS and OS rates were observed. Further randomized studies are warranted.

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Contralateral regional recurrence after elective unilateral neck irradiation in oropharyngeal carcinoma: A literature-based critical review

Cited by 50 publications

References 37 publications

Patient-reported quality of life and toxicity in unilateral and bilateral radiotherapy for early-stage human papillomavirus associated tonsillar carcinoma

Patient-reported quality of life and toxicity in unilateral and bilateral radiotherapy for early-stage human papillomavirus associated tonsillar carcinoma

Lymphatic mapping with SPECT‐CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

Long‐term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study

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