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

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

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Summary Purpose To update the outcomes of an institutional clinical management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion. Methods and Materials Between August 2003 and April 2014, 61 consecutive patients with ipsilateral node-positive squamous cell carcinoma of the tonsil without involvement of the base of the tongue or midline soft palate were treated at a community hospital-based cancer center with radiotherapy to the primary site and ipsilateral neck. Overall survival, disease-free survival and freedom from contralateral failure were calculated. Results Median follow up was 37.2 months (range 4-121 months). Freedom from contralateral nodal failure at 5 years was 98% with one contralateral nodal failure noted. The patient underwent a salvage neck dissection and was treated with post-operative radiotherapy with no evidence of disease to date. 5-year overall survival (OS) was 92.4% and 5 year disease-free survival (DFS) was 86.7%. Conclusions This represents the single largest series reported from a community hospital-based cancer center in which lateralized tonsil cancers with N+ disease were treated with ipsilateral neck radiotherapy. In this carefully selected cohort of patients with well-lateralized tonsil cancers, the risk of contralateral nodal failure appears to be <5%, suggesting that prophylactic radiation of the contralateral neck may not be necessary. Future planned studies will focus on prospectively selecting subgroups of patients eligible for treatment de-intensification as survivorship issues in excellent prognosis HPV positive patients are increasingly becoming relevant.

Original languageEnglish (US)
Article number3219
Pages (from-to)616-621
Number of pages6
JournalOral Oncology
Volume51
Issue number6
DOIs
StatePublished - Jun 1 2015

Keywords

  • HPV
  • Ipsilateral radiation
  • Oropharynx
  • Tonsillar cancer

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

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