Risk of Occult Contralateral Neck Metastasis in Early-Stage HPV-Related Lateralized Cancer of the Base of the Tongue.

Abstract

(1) To determine the incidence of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated base-of-tongue (BOT) oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery; and (2) to compare survival and recurrence in patients who did and did not undergo contralateral neck treatment. Contralateral neck management in patients with early-stage HPV+ OPSCC of the BOT treated surgically remains controversial. Despite lacking data, most patients receive surgery and/or radiation to the contralateral neck based on historical incidence of occult lymph node metastasis in OPSCC. A retrospective chart review of patients with AJCC 7th edition pT1-2, pN0-1 HPV+ BOT OPSCC undergoing transoral robotic BOT resection and ipsilateral neck dissection with adjuvant treatment was conducted. The incidence of occult contralateral nodal metastasis was assessed. Overall and disease-free survival were compared between patients who did and did not undergo contralateral neck treatment. Of 106 patients meeting inclusion criteria, 46 (43.3%) did not undergo treatment of the contralateral neck with radiation or lymphadenectomy, whereas 29 (27.4%) received radiation alone to the contralateral neck, and 31 (29.2%) underwent elective contralateral neck dissection without identification of occult metastasis in any case. Overall survival (HR: 0.95, 95% CI: 0.23-4.00) and disease-free survival (HR: 1.43, CI: 0.55-3.71) did not significantly differ between patients who did and did not receive treatment to the contralateral neck. Risk of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated BOT OPSCC treated with primary surgery was low, prompting consideration of forgoing contralateral neck treatment in these patients.