Clinical nodal staging of T1-2 tonsillar squamous cell carcinoma stratified by p16 status and implications for ipsilateral neck irradiation.
OBJECTIVE
Previous studies have reported <5% incidence of contralateral nodal metastasis in patients with T1-2 tonsillar squamous cell carcinoma. We analyzed the nodal staging of T1-2 tonsillar squamous cell carcinoma stratified for p16 status, a marker of human papillomavirus positivity.


METHODS
Clinical and radiographic nodal staging and p16 status of 41 T1-2 tonsillar squamous cell carcinoma patients who were treated between January 2002 and June 2009 were retrospectively analyzed. Patients with a history of prior head and neck cancer, synchronous cancers, base of tongue or soft palate invasion, or distant metastases at diagnosis were excluded.


RESULTS
Of the 41 patients, 28 (68.2%) had p16+ tumors and 13 (31.7%) had p16- tumors. Seven patients (17.0%) presented with contralateral cervical nodal disease, all of whom had p16+ tumors. Furthermore, 25.0% of patients with p16+ tumors presented with contralateral cervical nodal disease compared with 0% of patients with p16- tumors.


CONCLUSIONS
Patients with p16+ T1-2 tonsillar squamous cell carcinoma present with a higher incidence of contralateral nodal spread than those patients with p16- disease. This may have clinical implications when determining which patients are good candidates for ipsilateral cervical nodal irradiation.
Departments of Radiation Oncology, University of Virginia, Charlottesville, VA 22903, USA.
Asal N
AN
Shoushtari
Mathew
M
Meeneghan
Gregory C
GC
Treharne
James F
JF
Reibel
Paul A
PA
Levine
Christopher A
CA
Moskaluk
Mark J
MJ
Jameson
Paul W
PW
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D014408:Biomarkers, Tumor / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000473:pathology* / Q000532:radiotherapy; D019941:Cyclin-Dependent Kinase Inhibitor p16; D006801:Humans; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D009363:Neoplasm Proteins / Q000378:metabolism*; D012189:Retrospective Studies; D014067:Tonsillar Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000532:radiotherapy
D014408:Biomarkers, Tumor; C000614131:CDKN2A protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D009363:Neoplasm Proteins