Unilateral neck therapy in the human papillomavirus ERA: accepted regional spread patterns.
BACKGROUND
The purpose of this study was to determine whether the incidence of bilateral neck disease tonsillar cancer is rising.


METHODS
We reviewed tonsillar cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute.


RESULTS
The annual incidence of advanced neck disease (≥N2) with small primary tonsillar cancer is increasing (annual percent change [APC]; p < .05) during 2 evaluable time frames (1988-2003 and 2004-2008). The increase for small primary tonsillar cancer from 2004 to 2008 is associated with increased ipsilateral disease (ie, T1-2N2a-b, APC 10.6%; p < .05) rather than bilateral neck disease (T1-2N2c, APC 5.9%, APC = NS). The increase in bilateral neck disease is less than the overall rise in T1 to 2 tonsillar cancer (APC 7.2%; p < .05).


CONCLUSIONS
In the human papillomavirus (HPV) era, bilateral neck disease is increasingly common. This seems to be a consequence of the increasing incidence of tonsillar cancer rather than a new biologic behavior.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. Thomas.galloway@fccc.edu
Thomas J
TJ
Galloway
Miriam N
MN
Lango
Barbara
B
Burtness
Ranee
R
Mehra
Karen
K
Ruth
John A
JA
Ridge
D017677:Age Distribution; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D016208:Databases, Factual; D005260:Female; D007839:Functional Laterality; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D017678:Sex Distribution; D016019:Survival Analysis; D014067:Tonsillar Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000821:virology*; D014481:United States / Q000453:epidemiology