Premium
Neck metastases in oropharyngeal cancer: Necessity and extent of bilateral treatment
Author(s) -
Dziegielewski Peter T.,
O'Connell Daniel A.,
Szudek Jacek,
Barber Brittany,
Joshi Arjun,
Harris Jeffrey R.,
Seikaly Hadi
Publication year - 2013
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.23172
Subject(s) - medicine , head and neck cancer , head and neck squamous cell carcinoma , neck dissection , head and neck , logistic regression , basal cell , cancer , surgery , radiology
Background Bilateral neck treatment in oropharyngeal squamous cell carcinoma (OPSCC) is controversial. This study determined the rate of bilateral neck metastases in OPSCC and formulated a neck treatment algorithrm for OPSCC. Methods In all, 212 consecutive patients with OPSCC underwent ipsilateral level I–V and contralateral I–III or I–V neck dissections. Pathology results were used to identify factors predicting bilateral neck metastases. Results A total of 171 patients (81%) had ipsilateral and 41 patients (24%) bilateral neck metastases. Multivariate logistic regression found cT4 and ≥cN 2a significantly associated with contralateral neck metastases ( p < .05). However, tumor site was not predictive ( p > .05). High‐risk pathology features predicted contralateral neck disease ( p < .05). cN0 and cN1 necks were unlikely to harbor disease in level V (<5%). Both 2‐ and 5‐year contralateral neck recurrence rates were 1% and 2%. Conclusions Bilateral neck disease in OPSCC is more common than once thought. Patients with OPSCC with cT4 or cN 2a+ would benefit from bilateral neck treatment. Posttreatment high‐risk features should guide treatment escalation. © 2012 Wiley Periodicals, Inc. Head Neck 35: 1461–1467, 2013