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. 2015 Aug;38(4):343-7.
doi: 10.1097/COC.0000000000000064.

Sparing bilateral neck level IB in oropharyngeal carcinoma and xerostomia outcomes

Moses Tam  1 , Nadeem Riaz, Danita Kannarunimit, Angela P Peña, Karen D Schupak, Daphna Y Gelblum, Suzanne L Wolden, Shyam Rao, Nancy Y Lee
Affiliations

Sparing bilateral neck level IB in oropharyngeal carcinoma and xerostomia outcomes

Moses Tam et al. Am J Clin Oncol. 2015 Aug.

Abstract

Objectives: To assess whether sparing neck-level IB in target delineation of node-positive (N+) oropharyngeal carcinoma (OPC) can improve xerostomia outcomes without compromising locoregional control (LRC).

Methods: A total of 125 N+ OPC patients with a median age of 57 years underwent chemoradiation between May 2010 and December 2011. A total of 74% of patients had T1-T2 disease, 26% T3-T4, 16% N1, 8% N2A, 48% N2B, 28% N2C; 53% base of tongue, 41% tonsil, and 6% other. Patients were divided into those who had target delineation sparing of bilateral level IB (the spared cohort) versus no sparing (the treated cohort). Sparing of contralateral high-level II nodes was also performed more consistently in the spared cohort. A prospective xerostomia questionnaire (patient reported) was given at each patient follow-up visit to this cohort of patients to assess late xerostomia. Clinical assessment (observer rated) at each patient follow-up visit was also recorded.

Results: The 2-year LRC for the spared and treated cohorts was 97.5% and 93.8%, respectively (median follow-up, 23.2 mo). No locoregional failures occurred outside of treatment fields. The spared cohort experienced significant benefits in patient-reported xerostomia summary scores (P=0.021) and observer-rated xerostomia scores (P=0.006). In addition, there were significant reductions in mean doses to the ipsilateral submandibular gland (63.9 vs. 70.5 Gy; P<0.001), contralateral submandibular gland (45.0 vs. 56.2 Gy; P<0.001), oral cavity (35.9 vs. 45.2 Gy; P<0.001), and contralateral parotid gland (20.0 vs. 24.4 Gy; P<0.001).

Conclusions: Target delineation sparing of bilateral level IB nodes in N+ OPC reduced mean doses to salivary organs without compromising LRC. Patients with reduced target volumes had better patient-reported xerostomia outcomes.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Bilateral level IB (blue) with PTV70 (red) and PTV59.4 (orange). Left: Contouring (blue) of bilateral level IB lymph nodes. Right: Sparing of bilateral level IB lymph nodes. The clinical target volume (CTV) and planning target volume (PTV) may extend into the posterior aspect of level IB to provide sufficient coverage when a node is abutting level IB.
FIGURE 2
FIGURE 2
Local-regional control and overall survival.
FIGURE 3
FIGURE 3
Observer-rated late xerostomia.
See this image and copyright information in PMC

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