Low rates of contralateral neck failure in unilaterally treated oropharyngeal squamous cell carcinoma with prospectively defined criteria of lateralization

Hu, Kenneth; Mourad, W.F.; Gamez, M.E.; Safdieh, Joseph; Lin, Wilson; Jacobson, Adam S.; Persky, Mark S.; Urken, Mark L.; Culliney, B.; Li, Zujun; Tran, Theresa; Schantz, Stimson P.; Chadha, Juskaran; Harrison, Louis B.

doi:10.1002/hed.24806

Cited by 16 publications

(30 citation statements)

References 28 publications

(68 reference statements)

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“…In this series, 4/37 patients had T3 disease and 21/37 (62%) had multiple involved ipsilateral nodes ≤6 cm in diameter. The 3‐year locoregional control, contralateral neck progression, distant metastasis, and disease‐free survival rates were 96%, 0%, 7%, and 93%, respectively 15 …”

Section: Resultsmentioning

confidence: 99%

“…Additional studies including patients with somewhat more advanced T‐ and N‐categories (see Table 1) have been reported. Medial extension appears to be an important determinant for appropriately selecting patients for ipsilateral neck radiation in the published reports with low contralateral nodal failure rates; primary tumors need to be at least 1 cm from midline at the most medial extent 12,15 or involve <1 cm of involvement of base of tongue and/or soft palate 13,14,17 …”

Section: Resultsmentioning

confidence: 99%

“…The 3-year locoregional control, contralateral neck progression, distant metastasis, and disease-free survival rates were 96%, 0%, 7%, and 93%, respectively. 15 Several other retrospective series reported low rates of contralateral nodal failure in select patients. In a series of 76 patients who received unilateral RT, with a median follow-up of 7.1 years, there was a single contralateral neck recurrence in level III for a patient with cT1 tonsil cancer and multiple ipsilateral nodes ≤6 cm.…”

Section: Topic 1: Updated Literature On Clinically Staged Tonsil Camentioning

confidence: 96%

“…Additional studies including patients with somewhat more advanced T-and N-categories (see Table 1) have been reported. Medial extension appears to be an important determinant for appropriately selecting patients for ipsilateral neck radiation in the published reports with low contralateral nodal failure rates; primary tumors need to be at least 1 cm from midline at the most medial extent 12,15 or involve <1 cm of involvement of base of tongue and/or soft palate. 13,14,17 Although the data are limited, the published experiences demonstrate low rates of contralateral failure in both p16-positive and p16-negative subsets, suggesting that a separate selection algorithm based on p16 status is not warranted.…”

Section: Topic 1: Updated Literature On Clinically Staged Tonsil Camentioning

confidence: 99%

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Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary

et al. 2020

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Background: We conducted the current systemic review to provide up-to-date literature summary and optimal evidence-based recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil. Methods: We performed literature search of peer-reviewed journals through PubMed. The search strategy and subject-specific keywords were developed based on the expert panel's consensus. Articles published from January 2000 to May 2020 with full text available on PubMed and restricted to the English language and human subjects were included. Several prespecified search terms were used to identify relevant publications and additional evidence published since the initial American College of Radiology Appropriateness Criteria Members of the ARS Appropriate Use Criteria Steering Committee seek and encourage collaboration with other organizations on the development of the Criteria through representation on expert panels. Participation by representatives from collaborating organizations on the expert panel does not necessarily imply individual or society endorsement of the final document.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Topic 1: Updated Literature On Clinically Staged Tonsil Camentioning

confidence: 96%

Section: Topic 1: Updated Literature On Clinically Staged Tonsil Camentioning

confidence: 99%

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Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary

et al. 2020

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“…The opposing argument for BRT is to reduce the risk of CNF. In the setting of a well-lateralized tonsillar tumour, low rates of CNF have been reported with URT where there are multiple ipsilateral neck nodes [3][4][5][6][7][8][9][10][11][12][13][14]. Following URT, these series also suggest that salvage is largely successful where CNF is isolated.…”

Section: Introductionmentioning

confidence: 82%

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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Association of Unilateral Radiotherapy With Contralateral Lymph Node Failure Among Patients With Squamous Cell Carcinoma of the Tonsil

et al. 2023

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ImportanceIpsilateral neck radiotherapy (RT) is controversial in some patients with tonsil cancer due to concern for nodal failure within the contralateral nonirradiated neck (hereinafter referred to as contralateral neck failure [CNF]).ObjectiveTo determine the rate of CNF following ipsilateral neck RT in patients with tonsil cancer.Data SourcesDatabases including PubMed, Embase, Web of Science, and Cochrane Library were queried for peer-reviewed, English language articles published between January 1, 1980, and December 31, 2021.Study SelectionStudies reporting rates of CNF from at least 20 patients treated with ipsilateral neck RT. Studies were excluded if they lacked full text, reported results from databases or systematic reviews, or did not provide RT details.Data Extraction and SynthesisData were extracted following the PRISMA reporting guideline. Study quality was assessed using criteria from a methodological index for nonrandomized studies. Pooled outcomes were estimated using random-effects models.Main Outcomes and MeasuresPrimary outcome was the pooled rate of CNF following ipsilateral neck RT. Secondary outcomes were the pooled rates of CNF by tumor and nodal staging categories from the 7th edition of the AJCC Cancer Staging Manual and rates of toxic effects.ResultsA total of 17 studies (16 retrospective and 1 prospective) including 1487 unique patients were identified. The pooled risk of CNF was 1.9% (95% CI, 1.2%-2.6%). The rate of CNF by tumor (T) category was as follows: 1.3% (95% CI, 0.3%-2.3%) for T1; 3.0% (95% CI, 1.6%-4.4%) for T2; 11.3% (95% CI, 3.3%-19.2%) for T3; and 16.0% (95% CI, −7.8% to 39.8%) for T4. Patients with T3 to T4 tumors had a significantly higher rate of CNF than those with T1 to T2 tumors (11.5% [95% CI, 3.9%-19.1%] vs 1.8% [95% CI, 1.0%-2.6%]; P &lt; .001). The rate of CNF by nodal (N) category was 1.2% (95% CI, 0.1%-2.2%) for N0; 4.8% (95% CI, 2.4%-7.2%) for N1; 3.1% (95% CI, 0.4%-5.8%) for N2a; 3.1% (95% CI, 1.2%-4.9%) for N2b; and 0 (95% CI, not applicable) for N3. Rates of CNF were similar for patients with N2b to N3 and N0 to N2a disease (3.0% [95% CI, 1.2%-4.7%] vs 1.7% [95% CI, 0.6%-2.8%], respectively; P = .07). Compared with bilateral RT, ipsilateral RT was associated with increased risk of CNF (log odds ratio, 1.29 [95% CI, 0.09-2.48]; P = .04). The crude rates of xerostomia of grade 3 or greater and feeding tube use were 0.9% (95% CI, –0.2% to 1.9%) and 13.3% (95% CI, 8.3%-18.3%), respectively.Conclusions and RelevanceIn this systematic review and meta-analysis, ipsilateral neck RT was associated with a low rate of CNF in patients with small, lateralized tonsil cancers. Bilateral neck RT was associated with lower risk of CNF compared with ipsilateral neck RT. Patients with tumors of a higher T category were at increased risk for CNF following ipsilateral neck RT, and advanced nodal stage was not associated with CNF. Rates of toxic effects appeared favorable in patients treated with ipsilateral neck RT.

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Low rates of contralateral neck failure in unilaterally treated oropharyngeal squamous cell carcinoma with prospectively defined criteria of lateralization

Abstract: Low rates of contralateral neck failure are demonstrated utilizing prospectively defined criteria for unilateral RT. The tolerances of contralateral organs are respected and patients report low to moderate levels of distress throughout treatment.

Cited by 16 publications

References 28 publications

Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary

Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary

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

Association of Unilateral Radiotherapy With Contralateral Lymph Node Failure Among Patients With Squamous Cell Carcinoma of the Tonsil

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