title: Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: updated results of an institutional clinical management approach.
abstract: OBJECTIVE
  To update the outcomes of an institutional clinical management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion.
  
  
  METHODS
  Between August 2003 and April 2014, 61 consecutive patients with ipsilateral node-positive squamous cell carcinoma of the tonsil without involvement of the base of the tongue or midline soft palate were treated at a community hospital-based cancer center with radiotherapy to the primary site and ipsilateral neck. Overall survival, disease-free survival and freedom from contralateral failure were calculated.
  
  
  RESULTS
  Median follow up was 37.2months (range 4-121months). Freedom from contralateral nodal failure at 5years was 98% with one contralateral nodal failure noted. The patient underwent a salvage neck dissection and was treated with post-operative radiotherapy with no evidence of disease to date. 5-year overall survival (OS) was 92.4% and 5year disease-free survival (DFS) was 86.7%.
  
  
  CONCLUSIONS
  This represents the single largest series reported from a community hospital-based cancer center in which lateralized tonsil cancers with N+ disease were treated with ipsilateral neck radiotherapy. In this carefully selected cohort of patients with well-lateralized tonsil cancers, the risk of contralateral nodal failure appears to be <5%, suggesting that prophylactic radiation of the contralateral neck may not be necessary. Future planned studies will focus on prospectively selecting subgroups of patients eligible for treatment de-intensification as survivorship issues in excellent prognosis HPV positive patients are increasingly becoming relevant.
authors: Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States.
authors: Tu D
authors: TD
authors: Dan
authors: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO, United States.
authors: David
authors: D
authors: Raben
authors: Head and Neck Multidisciplinary Group, Helen F. Graham Cancer Center, Wilmington, DE, United States.
authors: Charles J
authors: CJ
authors: Schneider
authors: Head and Neck Multidisciplinary Group, Helen F. Graham Cancer Center, Wilmington, DE, United States.
authors: Neil G
authors: NG
authors: Hockstein
authors: Head and Neck Multidisciplinary Group, Helen F. Graham Cancer Center, Wilmington, DE, United States.
authors: Robert L
authors: RL
authors: Witt
authors: Head and Neck Multidisciplinary Group, Helen F. Graham Cancer Center, Wilmington, DE, United States.
authors: Michael
authors: M
authors: Dzeda
authors: Head and Neck Multidisciplinary Group, Helen F. Graham Cancer Center, Wilmington, DE, United States.
authors: Jennifer F
authors: JF
authors: Cormier
authors: Head and Neck Multidisciplinary Group, Helen F. Graham Cancer Center, Wilmington, DE, United States. Electronic address: ARaben@Christianacare.org.
authors: Adam
authors: A
authors: Raben
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D014067:Tonsillar Neoplasms / Q000532:radiotherapy* / Q000601:surgery
keywords: HPV; Ipsilateral radiation; Oropharynx; Tonsillar cancer