Management of contralateral N0 neck in tonsillar squamous cell carcinoma

Young Chang Lim, Sei Young Lee, Jae Yol Lim, Hyang Ae Shin, Jin Seok Lee, Bon Seok Koo, Se Heon Kim, Eun Chang Choi

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objectives: It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory dining initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. Materials and Methods: A retrospective analysis of 43 NO-3 tonsillar cancer patients with contralateral clinically negative necks from 1092 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. Results: Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16% (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21% (7 of 33), in contrast with 0% in ipsilateral NO necks. On the basis of the clinical staging of the tumor, 5% (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36% (5 of 14) in T3, and 25% (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92% vs. 28%, F = < .05). Conclusion: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21%), and patients who present with a contracterai metastatic neck have a worse prognosis than those who are staged as NO. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.

Original languageEnglish
Pages (from-to)1672-1675
Number of pages4
JournalLaryngoscope
Volume115
Issue number9
DOIs
Publication statusPublished - 2005 Sep 1

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Squamous Cell Carcinoma
Neck
Lymph Nodes
Neoplasm Metastasis
Tonsillar Neoplasms
Survival Rate
Neoplasms
Neck Dissection
Neoplasm Staging
Therapeutics
Radiotherapy
Carcinoma
Survival

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

Lim, Y. C., Lee, S. Y., Lim, J. Y., Shin, H. A., Lee, J. S., Koo, B. S., ... Choi, E. C. (2005). Management of contralateral N0 neck in tonsillar squamous cell carcinoma. Laryngoscope, 115(9), 1672-1675. https://doi.org/10.1097/01.mlg.0000184791.68804.0b
Lim, Young Chang ; Lee, Sei Young ; Lim, Jae Yol ; Shin, Hyang Ae ; Lee, Jin Seok ; Koo, Bon Seok ; Kim, Se Heon ; Choi, Eun Chang. / Management of contralateral N0 neck in tonsillar squamous cell carcinoma. In: Laryngoscope. 2005 ; Vol. 115, No. 9. pp. 1672-1675.
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abstract = "Objectives: It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory dining initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. Materials and Methods: A retrospective analysis of 43 NO-3 tonsillar cancer patients with contralateral clinically negative necks from 1092 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. Results: Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16{\%} (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21{\%} (7 of 33), in contrast with 0{\%} in ipsilateral NO necks. On the basis of the clinical staging of the tumor, 5{\%} (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36{\%} (5 of 14) in T3, and 25{\%} (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92{\%} vs. 28{\%}, F = < .05). Conclusion: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21{\%}), and patients who present with a contracterai metastatic neck have a worse prognosis than those who are staged as NO. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.",
author = "Lim, {Young Chang} and Lee, {Sei Young} and Lim, {Jae Yol} and Shin, {Hyang Ae} and Lee, {Jin Seok} and Koo, {Bon Seok} and Kim, {Se Heon} and Choi, {Eun Chang}",
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Lim, YC, Lee, SY, Lim, JY, Shin, HA, Lee, JS, Koo, BS, Kim, SH & Choi, EC 2005, 'Management of contralateral N0 neck in tonsillar squamous cell carcinoma', Laryngoscope, vol. 115, no. 9, pp. 1672-1675. https://doi.org/10.1097/01.mlg.0000184791.68804.0b

Management of contralateral N0 neck in tonsillar squamous cell carcinoma. / Lim, Young Chang; Lee, Sei Young; Lim, Jae Yol; Shin, Hyang Ae; Lee, Jin Seok; Koo, Bon Seok; Kim, Se Heon; Choi, Eun Chang.

In: Laryngoscope, Vol. 115, No. 9, 01.09.2005, p. 1672-1675.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Management of contralateral N0 neck in tonsillar squamous cell carcinoma

AU - Lim, Young Chang

AU - Lee, Sei Young

AU - Lim, Jae Yol

AU - Shin, Hyang Ae

AU - Lee, Jin Seok

AU - Koo, Bon Seok

AU - Kim, Se Heon

AU - Choi, Eun Chang

PY - 2005/9/1

Y1 - 2005/9/1

N2 - Objectives: It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory dining initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. Materials and Methods: A retrospective analysis of 43 NO-3 tonsillar cancer patients with contralateral clinically negative necks from 1092 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. Results: Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16% (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21% (7 of 33), in contrast with 0% in ipsilateral NO necks. On the basis of the clinical staging of the tumor, 5% (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36% (5 of 14) in T3, and 25% (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92% vs. 28%, F = < .05). Conclusion: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21%), and patients who present with a contracterai metastatic neck have a worse prognosis than those who are staged as NO. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.

AB - Objectives: It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory dining initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. Materials and Methods: A retrospective analysis of 43 NO-3 tonsillar cancer patients with contralateral clinically negative necks from 1092 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. Results: Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16% (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21% (7 of 33), in contrast with 0% in ipsilateral NO necks. On the basis of the clinical staging of the tumor, 5% (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36% (5 of 14) in T3, and 25% (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92% vs. 28%, F = < .05). Conclusion: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21%), and patients who present with a contracterai metastatic neck have a worse prognosis than those who are staged as NO. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.

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