Ipsilateral Neck Radiation in Lateralized Oropharynx Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO

  • O’Sullivan et al:
    • Reported the results of a large retrospective review which identified oropharyngeal tumors that could be spared by contralateral ENI
  • Two hundred twenty-eight (280) patients with tonsillar carcinomas were treated with ipsilateral radiotherapy at Princess Margaret Hospital
  • Eligible patients typically had T1 or T2 tumors (191 T1 to T2, 30 T3, 7 T4) with N0 (133 N0, 35 N1, 27 N2 to N3) disease
  • Radiation was typically delivered with wedged pair Cobalt beams and ipsilateral low anterior neck field delivering 50 Gy in 4 weeks to the primary volume
  • At a median follow-up of 5.7 years:
    • The 3-year local control rate was 77%
    • Regional control rate was 80%
    • Cause-specific survival was 76%
    • Contralateral neck failure occurred in 3% (8/228)
    • All patients with T1 lesions or N0 neck status:
      • Had 100% contralateral neck control
    • Patients with a 10% or greater risk of contralateral neck failure included those with:
      • T3 lesions, lesions involving the medial one-third of the hemi-soft palate, tumors invading the middle third of the ipsilateral base of tongue, and patients with N1 disease
      • In the presence of ipsilateral node metastases:
        • The risk for contralateral neck failure was 9.5%, 14%, and 21% (all crude rates) for involvement of the soft palate, the base of tongue, and both structures, respectively
    • However, the authors appropriately note the limitations of these observations as they included patients with uncontrolled primaries and involved a total of only eight patients with contralateral neck failures
    • Despite this, the report provides confidence in the selection of patients with T1 N0 tonsil carcinomas (as well as selected patients with more advanced disease) for only ipsilateral ENI
    • Similar observations were also reported by Jackson et al. further supporting these observations
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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