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Head and Neck Surgery

Outcomes After Elective Contralateral Neck Dissection for HPV-Related Oropharyngeal Cancer

Monday, October 2, 2023
8:36 AM - 8:42 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Ray Y. Wang, MD

    Assistant Professor
    Baylor College of Medicine
    Houston, TX, United States

    • Co-Author(s)

  • Molly E. Heft Neal, MD

    Assistant Professor, Department of Otolaryngology- Head and Neck Surgery
    University of Michigan
    Ann Arbor, MI, United States

  • Sid V. Puram, MD PHD

    Chief, Head and Neck Surgery
    Washington University - St. Louis
    St Louis, MO, United States

    • Senior Author(s)

  • RJ

    Ryan S. Jackson, MD

    Associate Professor
    Washington University School of Medicine
    St. Louis, MO, United States

Disclosure(s):
Ray Y. Wang, MD: No relevant relationships to disclose.
Molly E. Heft Neal, MD: No relevant relationships to disclose.
Ryan S. Jackson, MD: No relevant relationships to disclose.
Introduction: Patients with HPV-related oropharyngeal squamous cell carcinoma (OPSCC), particularly of the base of tongue, have a high rate of occult nodal disease in the contralateral neck. Risk of failure in the contralateral neck is reduced with elective treatment. While radiotherapy yields good oncologic outcomes, it is associated with significant acute and long-term toxicities. The optimal treatment strategy to minimize treatment-related toxicity while preserving regional control in the contralateral neck has not been elucidated.

Methods: This was a retrospective cohort study of all patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between November 2005 and December 2018 at a tertiary care center.

Results: 64 patients met criteria for inclusion with a median follow-up of 58.5 months. 56 patients (88%) had a primary cancer within the base of tongue or glossotonsillar sulcus. 12 patients (19%) were found to have occult nodal metastasis in the contralateral neck; of these, 9 patients completed adjuvant radiation to the contralateral neck. None of the patients who had node-negative contralateral neck dissections went on to receive radiation in the contralateral neck. 2 patients (3%) recurred locally, 2 patients (3%) developed ipsilateral regional recurrence, and 4 patients (6%) developed distant metastasis. There were no regional recurrences within the contralateral neck.  5-year progression-free survival was 82.0% while 5-year locoregional control was 93.0%. 3 patients (5%) had perioperative complications from their contralateral neck dissection with one patient requiring return to the operating room.

Conclusions: Elective contralateral neck dissection in patients with HPV-related OPSCC provides excellent regional control, and most patients can be spared contralateral neck radiation without compromising oncologic outcomes. This may decrease long-term toxicity related to bilateral neck irradiation.