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Low risk of contralateral lymph node recurrence in lateralized head and neck carcinoma after postoperative ipsilateral radiotherapy

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Abstract

Purpose

The role of postoperative irradiation to contralateral non-involved neck nodes in lateralized carcinoma of the head and neck is not clear. The contralateral neck failure rate in head and neck carcinoma treated postoperatively with ipsilateral neck irradiation only was evaluated.

Methods

Patients with carcinoma of the oral cavity, oropharynx, or hypopharynx without midline extension treated between 1990 and 2016 were analyzed. After tumor resection and neck dissection (ND), radiotherapy was given to the primary tumor site and ipsilateral neck. High-risk patients additionally received concurrent chemotherapy. Freedom from contralateral neck recurrence (FCNR), locoregional control rate (LRC), overall survival (OS), and disease-free survival (DFS) were evaluated.

Results

197 patients (median age 60.7 years, 66.5% males, 52.8% oropharyngeal carcinomas) were analyzed. Complete resection (R0) was achieved in 85.8% of cases. Ipsilateral ND was performed in all patients and contralateral ND in 144 patients (73.1%). Concurrent chemotherapy was given to 59 patients (30.0%). After a median follow-up of 45.5 months, OS and DFS of all patients were 73.6% and 70.9% at 5 years, respectively. A total of 45 patients (22.8%) suffered from a locoregional recurrence, lymph node metastases of the contralateral neck developed in 12 patients (6.1%) only. There was no significant difference in contralateral nodal failure rate with or without performance of contralateral ND.

Conclusion

Regional failure of the contralateral neck was low after surgery and ipsilateral neck irradiation in head and neck carcinomas without midline extension, supporting evidence that contralateral neck radiotherapy can safely be omitted in selected cases.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne/Koeln, Germany

    Mirja M. Wirtz MD, Susanne Temming, Martin Kocher, Sabine Kunze & Robert Semrau

  2. Department of Internal Medicine, Geisinger Medical Center, 100 N Academy Ave, 17822, Danville, PA, USA

    Mirja M. Wirtz MD

  3. Department of Radiation Oncology, Robert-Janker Klinik, Villenstr. 8, 53129, Bonn, Germany

    Susanne Temming

  4. Strahlentherapie Bonn Rhein-Sieg, Hospitalstr. 45, 53840, Troisdorf, Germany

    Robert Semrau

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  1. Mirja M. Wirtz MD
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Correspondence to Mirja M. Wirtz MD.

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Conflict of interest

M.M. Wirtz, S. Temming, M. Kocher, S. Kunze, and R. Semrau declare that they have no competing interests.

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Mirja M. Wirtz and Susanne Temming share first authorship.

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Wirtz, M.M., Temming, S., Kocher, M. et al. Low risk of contralateral lymph node recurrence in lateralized head and neck carcinoma after postoperative ipsilateral radiotherapy. Strahlenther Onkol 196, 474–484 (2020). https://doi.org/10.1007/s00066-019-01556-0

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  • DOI: https://doi.org/10.1007/s00066-019-01556-0

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