Caitlin P McMullen1, Jonathan Garneau2, Emillie Weimar3, Sana Ali4, Joaquim M Farinhas4, Eugene Yu3, Peter M Som5, Cathy Sarta6, David P Goldstein1, Susie Su7, Wei Xu7, Richard V Smith6, Brett Miles2, John R de Almeida8. 1. University of Toronto, Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Center, 610 University Avenue, 3-955, Toronto, ON M5G 2M9, United States. 2. Icahn School of Medicine at Mount Sinai, Department of Otolaryngology Head and Neck Surgery, One Gustave L. Levy Place, Box 1189, New York, NY 10029, United States. 3. University of Toronto, Department of Medical Imaging, Princess Margaret Cancer Center, 610 University Ave., Toronto, ON M5G 2M9, United States. 4. Montefiore Medical Center, Albert Einstein College of Medicine, Department of Radiology, 111 East 210th Street, Bronx, NY 10467, United States. 5. Icahn School of Medicine at Mount Sinai, Department of Radiology, 1176 Fifth Avenue, New York, NY 10029, United States. 6. Montefiore Medical Center, Albert Einstein College of Medicine, Department of Otolaryngology Head & Neck Surgery, 3400 Bainbridge Avenue, Bronx, NY 10467-2404, United States. 7. Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, United States. 8. University of Toronto, Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Center, 610 University Avenue, 3-955, Toronto, ON M5G 2M9, United States; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. Electronic address: John.dealmeida@uhn.ca.
Abstract
BACKGROUND: Knowledge of the rate of occult contralateral nodal disease for oropharynx cancers (OPSCC) in the era of Human Papillomavirus-dominated disease would inform practitioners as to who may be a candidate for unilateral neck management. The objective of this study was to determine the rate of pathologic contralateral positive nodes in patients in OPSCC patients with pT1 and pT2 disease treated with TORS and bilateral neck dissections (BND). METHODS: Retrospective review of medical records was performed at Princess Margaret Cancer Center, Toronto; Icahn School of Medicine at Mount Sinai, New York City; and Montefiore Medical Center, New York City. Patients with pT1-2 N0-3 (AJCC 8th Edition) OPSCC disease treated with TORS and BND were included. RESULTS: Thirty-two patients met inclusion criteria. Twelve patients (37.5%) had a tonsil primary site, 19 (59.4%) patients had a base of tongue primary site, and 1 (3.1%) patient had a pharyngeal wall primary. Twenty-four (75%) patients were known to be p16+. Twenty-seven patients (84.4%) were radiographically negative in the contralateral neck preoperatively, and two of these patients had pathologic contralateral positive nodes. The occult pathologic contralateral nodal metastasis rate was 7.4% (2/27). The sensitivity, specificity, positive predictive value, and negative predictive value of suspicious contralateral nodes on preoperative imaging for pathologically positive nodes were 33.3%, 86.2%, 20% and 93% respectively. In the p16+ subgroup, the occult nodal positive rate in the contralateral neck was 5%. CONCLUSIONS: pT1-2 OPSCC patients undergoing TORS and elective contralateral neck dissection have a low rate of pathologic contralateral nodal positivity.
BACKGROUND: Knowledge of the rate of occult contralateral nodal disease for oropharynx cancers (OPSCC) in the era of Human Papillomavirus-dominated disease would inform practitioners as to who may be a candidate for unilateral neck management. The objective of this study was to determine the rate of pathologic contralateral positive nodes in patients in OPSCC patients with pT1 and pT2 disease treated with TORS and bilateral neck dissections (BND). METHODS: Retrospective review of medical records was performed at Princess Margaret Cancer Center, Toronto; Icahn School of Medicine at Mount Sinai, New York City; and Montefiore Medical Center, New York City. Patients with pT1-2 N0-3 (AJCC 8th Edition) OPSCC disease treated with TORS and BND were included. RESULTS: Thirty-two patients met inclusion criteria. Twelve patients (37.5%) had a tonsil primary site, 19 (59.4%) patients had a base of tongue primary site, and 1 (3.1%) patient had a pharyngeal wall primary. Twenty-four (75%) patients were known to be p16+. Twenty-seven patients (84.4%) were radiographically negative in the contralateral neck preoperatively, and two of these patients had pathologic contralateral positive nodes. The occult pathologic contralateral nodal metastasis rate was 7.4% (2/27). The sensitivity, specificity, positive predictive value, and negative predictive value of suspicious contralateral nodes on preoperative imaging for pathologically positive nodes were 33.3%, 86.2%, 20% and 93% respectively. In the p16+ subgroup, the occult nodal positive rate in the contralateral neck was 5%. CONCLUSIONS:pT1-2 OPSCC patients undergoing TORS and elective contralateral neck dissection have a low rate of pathologic contralateral nodal positivity.
Authors: Brett A Miles; Marshall R Posner; Vishal Gupta; Marita S Teng; Richard L Bakst; Mike Yao; Kryzsztof J Misiukiewicz; Raymond L Chai; Sonam Sharma; William H Westra; Seunghee Kim-Schulze; Bheesham Dayal; Stanislaw Sobotka; Andrew G Sikora; Peter M Som; Eric M Genden Journal: Oncologist Date: 2021-03-18