Unilateral neck therapy in the human papillomavirus ERA: accepted regional spread patterns

Abstract

Background: The purpose of this study was to determine whether the incidence of bilateral neck disease tonsillar cancer is rising.

Methods: We reviewed tonsillar cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute.

Results: The annual incidence of advanced neck disease (≥N2) with small primary tonsillar cancer is increasing (annual percent change [APC]; p < .05) during 2 evaluable time frames (1988-2003 and 2004-2008). The increase for small primary tonsillar cancer from 2004 to 2008 is associated with increased ipsilateral disease (ie, T1-2N2a-b, APC 10.6%; p < .05) rather than bilateral neck disease (T1-2N2c, APC 5.9%, APC = NS). The increase in bilateral neck disease is less than the overall rise in T1 to 2 tonsillar cancer (APC 7.2%; p < .05).

Conclusion: In the human papillomavirus (HPV) era, bilateral neck disease is increasingly common. This seems to be a consequence of the increasing incidence of tonsillar cancer rather than a new biologic behavior.

Figure 1

Incidence of N Stage of Tonsil Cancer and all stage Tonsil Cancer (1988–2008)

Figure 2

SEER incidence of Small Primary Tonsil Cancer by N-Stage, 1988–2008