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. 2023 Aug;280(8):3843-3853.
doi: 10.1007/s00405-023-07972-4. Epub 2023 May 3.

Outcomes following oropharyngeal squamous cell carcinoma resection and bilateral neck dissection with or without contralateral postoperative radiotherapy of the pathologically node-negative neck

Florian Jansen  1 , Christian Stephan Betz  2 , Matthias Hans Belau  3 , Gesa Matnjani  4 , Till Sebastian Clauditz  5 , Sebastian Dwertmann-Rico  5 , Katharina Stölzel  2 , Nikolaus Möckelmann #  2   6 , Arne Böttcher #  2
Affiliations

Outcomes following oropharyngeal squamous cell carcinoma resection and bilateral neck dissection with or without contralateral postoperative radiotherapy of the pathologically node-negative neck

Florian Jansen et al. Eur Arch Otorhinolaryngol. 2023 Aug.

Abstract

Purpose: There are no consensus guidelines regarding the postoperative treatment of the contralateral pathologically node-negative neck in oropharyngeal squamous cell carcinoma. This study aimed to determine if omission of postoperative irradiation of the contralateral pathologically node-negative neck affects oncological outcomes.

Methods: We retrospectively identified 84 patients with primary surgical treatment including bilateral neck dissection and postoperative (chemo-)radiotherapy (PO(C)RT). Survival was analyzed using the log-rank test and the Kaplan-Meier method.

Results: Patients showed no decrease in tumor-free, cause-specific (CSS), or overall survival (OS) when PO(C)RT of the contralateral pathologically node-negative neck was omitted. Increased OS was found in patients with unilateral PO(C)RT and especially an increased OS and CSS was found in unilateral PO(C)RT and in tumors arising from lymphoepithelial tissue.

Conclusions: Omitting the contralateral pathologically node-negative neck appears to be safe in terms of survival and our retrospective study advocates further prospective randomized control de-escalation trials.

Keywords: Adjuvant treatment; Contralateral neck; HPV; Neck irradiation; Oropharyngeal cancer.

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Conflict of interest statement

The authors have no financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Kaplan–Meier plots of tumor-free survival showing a no survival difference when comparing unilateral-to-bilateral postoperative [chemo-)radiotherapy (PO(C)RT) (log-rank (global): p = 0.106], b no survival difference when comparing unilateral to bilateral PO(C)RT stratified by p16 status [log-rank (global): p < 0.772; log-rank (stratified): p16-positive: p = 0.843; p16-negative: p = 0.829], c no survival difference when comparing unilateral to bilateral (PO(C)RT stratified by tonsil and/or BOT versus other regions [log-rank (global): p = 0.160; log-rank (stratified): tonsil and/or BOT: p = 0.092; other regions: p = 0.925], d no survival difference when comparing unilateral to bilateral PO(C)RT stratified by tonsil versus BOT [log-rank (global): p = 0.072; log-rank (stratified): tonsil: p = 0.128; BOT: p = 0.339], and e no survival difference when comparing unilateral to bilateral PORT stratified whether or not CRT was performed [log-rank (global): p = 0.085; log-rank (stratified): without CRT: p = 0.161; CRT: p = 0.307]. Other regions: palatopharyngeal arch, posterior pharyngeal wall, lateral pharyngeal wall, uvula. BOT base of tongue, CRT chemoradiotherapy
Fig. 2
Fig. 2
Kaplan–Meier plots of cause-specific survival showing a no survival difference when comparing unilateral to bilateral postoperative [chemo-)radiotherapy (PO(C)RT) (log-rank (global): p = 0.172], b no survival difference when comparing unilateral to bilateral PO(C)RT stratified by p16 status [log-rank (global): p < 0.310; log-rank (stratified): p16-positive: p = 0.068; p16-negative: p = 0.601], c survival difference when comparing unilateral to bilateral (PO(C)RT stratified by region with improved CSS in patients with unilateral PO(C)RT with tumors declared as tonsil and/or BOT [log-rank (global): p = 0.062; log-rank (stratified): tonsil and/or BOT: p = 0.029; other regions: p = 0.786], d no survival difference when comparing unilateral to bilateral (PO(C)RT stratified by tonsil versus BOT [log-rank (global): p = 0.062; log-rank (stratified): tonsil: p = 0.053; BOT: p = 0.462], and e no survival difference when comparing unilateral to bilateral PORT stratified whether or not CRT was performed [log-rank (global): p = 0.056; log-rank (stratified): without CRT: p = 0.186; CRT: p = 0.152]. Other regions: palatopharyngeal arch, posterior pharyngeal wall, lateral pharyngeal wall, uvula. BOT base of tongue, CRT chemoradiotherapy
Fig. 3
Fig. 3
Kaplan–Meier plots of overall survival (OS) showing a survival difference when comparing unilateral to bilateral postoperative [chemo-)radiotherapy (PO(C)RT) with improved survival in patients with unilateral PO(C)RT (log-rank (global): p = 0.043], b no survival difference when comparing unilateral to bilateral PO(C)RT stratified by p16 status [log-rank (global): p < 0.310; log-rank (stratified): p16-positive: p = 0.068; p16-negative: p = 0.601], c survival difference when comparing unilateral to bilateral PO(C)RT stratified by region with improved OS in patients with unilateral PO(C)RT with tumors in a region declared as tonsils and/or BOT [log-rank (global): p = 0.062; log-rank (stratified): tonsil and/or BOT: p = 0.029; other regions: p = 0.786], d no survival difference when comparing unilateral to bilateral (PO(C)RT stratified by tonsil versus BOT [log-rank (global): p = 0.098; log-rank (stratified): tonsil: p = 0.154; BOT: p = 0.386], and e no survival difference when comparing unilateral to bilateral PORT stratified whether or not CRT was performed [log-rank (global): p = 0.056; log-rank (stratified): without CRT: p = 0.186; CRT: p = 0.152]. Other regions: palatopharyngeal arch, posterior pharyngeal wall, lateral pharyngeal wall, uvula. BOT base of tongue, CRT chemoradiotherapy
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