title: Eliminating radiotherapy to the contralateral retropharyngeal and high level II lymph nodes in head and neck squamous cell carcinoma is safe and improves quality of life.
abstract: BACKGROUND
  Radiation treatment volumes in head and neck squamous cell carcinoma (HNSCC) are controversial. The authors report the outcomes, patterns of failure, and quality of life (QOL) of patients who received treatment for HNSCC using intensity-modulated radiation therapy (IMRT) that eliminated the treatment of contralateral retropharyngeal lymph nodes (RPLNs) in the clinically uninvolved neck.
  
  
  METHODS
  A prospective institutional database was used to identify patients who had primary oral cavity, oropharyngeal, hypopharyngeal, laryngeal, and unknown primary HNSCC for which they received IMRT. There were 3 temporal groups (generations 1-3). Generation 1 received comprehensive neck IMRT with parotid sparing, generation 2 eliminated the contralateral high level II (HLII) lymph nodes, and generation 3 further eliminated the contralateral RPLNs in the clinically uninvolved neck. Patterns of failure and survival analyses were completed, and QOL data measured using the MD Anderson Dysphagia Inventory were compared in a subset of patients from generations 1 and 3.
  
  
  RESULTS
  In total, 748 patients were identified. Of the 488 patients who received treatment in generation 2 or 3, 406 had a clinically uninvolved contralateral neck. There were no failures in the spared RPLNs (95% confidence interval, 0%-1.3%) or in the high contralateral neck (95% confidence interval, 0%-0.7%). QOL data were compared between 44 patients in generation 1 and 51 patients in generation 3. QOL improved both globally and in all domains assessed for generation 3, in which reduced radiotherapy volumes were used (P < .007).
  
  
  CONCLUSIONS
  For patients with locally advanced HNSCC, eliminating coverage to the contralateral HLII lymph nodes and contralateral RPLNs in the clinically uninvolved side of the neck is associated with minimal risk of failure in these regions and significantly improved patient-reported QOL.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Spencer
authors.forename: Hiram A
authors.initials: HA
authors.lastname: Gay
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Haughey
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Adkins
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Wildes
authors.forename: Todd A
authors.initials: TA
authors.lastname: DeWees
authors.forename: James S
authors.initials: JS
authors.lastname: Lewis
authors.forename: Wade L
authors.initials: WL
authors.lastname: Thorstad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects; D015182:Lymphatic Irradiation / Q000009:adverse effects* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009333:Neck; D010614:Pharynx; D011788:Quality of Life; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D047368:Tumor Burden; D028761:Withholding Treatment; D055815:Young Adult
keywords: head and neck squamous cell carcinoma; intensity-modulated radiotherapy; patterns of failure; quality of life; treatment volumes