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Ipsilateral neck radiotherapy in N2b well-lateralized tonsil cancer - Approach with caution
David Maskell1, Hannah Buckley1, Katherine Sission2
1Department of Oncology, Norfolk and Norwich University Hospital Foundation Trust, Norfolk, UK.
Background:
Treatment of the uninvolved neck in well-lateralized tonsillar squamous cell carcinoma is controversial. We became concerned after a number of contralateral neck recurrences (CNRs) in patients receiving ipsilateral radiotherapy (RT).
Methods:
This is a single center retrospective series including patients with well-lateralized tonsillar cancer treated with ipsilateral neck RT between 2004 and 2011.
Results:
We identified 53 patients treated with ipsilateral neck RT during the study period. The rate of CNR was 7.5% (4 of 53). All four patients had p16-positive, T1, N2b, M0 tumors. The subgroup of patients with N2b disease (28 of 53) had a CNR of 14.3%. We subsequently switched to treat patients with N2b with bilateral neck RT. We analyzed the outcomes of 23 patients with N2b treated with bilateral neck intensity-modulated RT (IMRT) and observed no CNRs.
Conclusions:
We observed a higher than expected rate of CNR in the N2b population. Bilateral neck IMRT for these patients represents a safe alternative.
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