Neck metastases in oropharyngeal cancer: Necessity and extent of bilateral treatment

作者：Dziegielewski Peter T^*; O' Connell Daniel A; Szudek Jacek; Barber Brittany; Joshi Arjun; Harris Jeffrey R; Seikaly Hadi

来源：Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 2013, 35(10): 1461-1467.

DOI：10.1002/hed.23172

• oropharyngeal cancer
• neck metastases
• bilateral neck treatment
• neck dissection
• treatment escalation

BackgroundBilateral neck treatment in oropharyngeal squamous cell carcinoma (OPSCC) is controversial. This study determined the rate of bilateral neck metastases in OPSCC and formulated a neck treatment algorithrm for OPSCC. %26lt;br%26gt;MethodsIn all, 212 consecutive patients with OPSCC underwent ipsilateral level I-V and contralateral I-III or I-V neck dissections. Pathology results were used to identify factors predicting bilateral neck metastases. %26lt;br%26gt;ResultsA total of 171 patients (81%) had ipsilateral and 41 patients (24%) bilateral neck metastases. Multivariate logistic regression found cT4 and cN(2a) significantly associated with contralateral neck metastases (p %26lt; .05). However, tumor site was not predictive (p %26gt; .05). High-risk pathology features predicted contralateral neck disease (p %26lt; .05). cN0 and cN1 necks were unlikely to harbor disease in level V (%26lt;5%). Both 2- and 5-year contralateral neck recurrence rates were 1% and 2%. %26lt;br%26gt;ConclusionsBilateral neck disease in OPSCC is more common than once thought. Patients with OPSCC with cT4 or cN(2a+) would benefit from bilateral neck treatment. Posttreatment high-risk features should guide treatment escalation.

• 出版日期2013-10