Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2025
Long-Term Outcomes After Elective Contralateral Neck Dissection for HPV-Related Oropharyngeal Cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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Wang Ray Y, Neal Molly E Heft, Thorstad Wade L, Gay Hiram A, Apicelli Anthony J, Moravan Michael J, Adkins Douglas R, Oppelt Peter J, Pipkorn Patrik, Rich Jason T, Zolkind Paul, Paniello Randal C, Puram Sidharth V, Jackson Ryan S
Аннотация
OBJECTIVE: Patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC), particularly of the base of tongue, have a high rate of occult nodal disease in the contralateral neck. The risk of failure in the contralateral neck is reduced with elective treatment. The optimal treatment strategy to minimize treatment-related toxicity while preserving regional control in the contralateral neck has not been elucidated.
STUDY DESIGN: Cross-sectional study of patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018.
SETTING: Tertiary care center.
METHODS: Patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018 were selected for inclusion. Long-term patient-reported functional outcomes were assessed via telephone at the time of data collection.
RESULTS: In total, 64 patients met the criteria for inclusion with a median follow-up of 58.5 months. In total, 56 patients (88%) had a primary cancer within the base of tongue or glossotonsillar sulcus. In total, 12 patients (19%) were found to have occult nodal metastasis in the contralateral neck, of whom 9 received adjuvant contralateral neck radiation. None of the patients who had node-negative contralateral neck dissections went on to receive radiation in the contralateral neck. Two patients (3%) recurred locally, two patients (3%) developed ipsilateral regional recurrence, and four patients (6%) developed distant metastasis. There were no regional recurrences within the contralateral neck. Five-year progression-free survival was 82.0%, whereas 5-year locoregional control was 93.0%. The mean Neck-Dissection Impairment Index was 94.4 with a median interval time of 92 months after surgery.
CONCLUSION: Elective contralateral neck dissection in patients with HPV-related OPSCC provides excellent regional control with minimal long-term functional impairment, and most patients can be spared contralateral neck radiation without compromising oncologic outcomes. This may decrease long-term toxicity related to bilateral neck irradiation.
STUDY DESIGN: Cross-sectional study of patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018.
SETTING: Tertiary care center.
METHODS: Patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018 were selected for inclusion. Long-term patient-reported functional outcomes were assessed via telephone at the time of data collection.
RESULTS: In total, 64 patients met the criteria for inclusion with a median follow-up of 58.5 months. In total, 56 patients (88%) had a primary cancer within the base of tongue or glossotonsillar sulcus. In total, 12 patients (19%) were found to have occult nodal metastasis in the contralateral neck, of whom 9 received adjuvant contralateral neck radiation. None of the patients who had node-negative contralateral neck dissections went on to receive radiation in the contralateral neck. Two patients (3%) recurred locally, two patients (3%) developed ipsilateral regional recurrence, and four patients (6%) developed distant metastasis. There were no regional recurrences within the contralateral neck. Five-year progression-free survival was 82.0%, whereas 5-year locoregional control was 93.0%. The mean Neck-Dissection Impairment Index was 94.4 with a median interval time of 92 months after surgery.
CONCLUSION: Elective contralateral neck dissection in patients with HPV-related OPSCC provides excellent regional control with minimal long-term functional impairment, and most patients can be spared contralateral neck radiation without compromising oncologic outcomes. This may decrease long-term toxicity related to bilateral neck irradiation.