title: Neck metastases in oropharyngeal cancer: Necessity and extent of bilateral treatment.
abstract: BACKGROUND
  Bilateral neck treatment in oropharyngeal squamous cell carcinoma (OPSCC) is controversial. This study determined the rate of bilateral neck metastases in OPSCC and formulated a neck treatment algorithrm for OPSCC.
  
  
  METHODS
  In all, 212 consecutive patients with OPSCC underwent ipsilateral level I-V and contralateral I-III or I-V neck dissections. Pathology results were used to identify factors predicting bilateral neck metastases.
  
  
  RESULTS
  A total of 171 patients (81%) had ipsilateral and 41 patients (24%) bilateral neck metastases. Multivariate logistic regression found cT4 and ≥cN2a significantly associated with contralateral neck metastases (p < .05). However, tumor site was not predictive (p > .05). High-risk pathology features predicted contralateral neck disease (p < .05). cN0 and cN1 necks were unlikely to harbor disease in level V (<5%). Both 2- and 5-year contralateral neck recurrence rates were 1% and 2%.
  
  
  CONCLUSIONS
  Bilateral neck disease in OPSCC is more common than once thought. Patients with OPSCC with cT4 or cN2a+ would benefit from bilateral neck treatment. Posttreatment high-risk features should guide treatment escalation.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Dziegielewski
authors.forename: Daniel A
authors.initials: DA
authors.lastname: O'Connell
authors.forename: Jacek
authors.initials: J
authors.lastname: Szudek
authors.forename: Brittany
authors.initials: B
authors.lastname: Barber
authors.forename: Arjun
authors.initials: A
authors.lastname: Joshi
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harris
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection / Q000379:methods* / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome