title: Contralateral neck failure in lateralized oral squamous cell carcinoma.
abstract: BACKGROUND
  Elective treatment of the contralateral clinically node-negative (cN0) neck is not routinely recommended for lateralized oral cavity squamous cell carcinoma (SCC). We sought to determine the failure rate in the untreated contralateral neck in patients with lateralized oral SCC undergoing treatment of the primary and ipsilateral neck and to identify any features placing patients at sufficient risk of contralateral regional failure to justify elective treatment.
  
  
  METHODS
  We identified 688 patients with oral SCC undergoing curative surgery ± adjuvant therapy between 1985 and 2012 from a prospectively collected database. Patients with midline primaries and those undergoing bilateral neck treatment were excluded. The primary endpoint was isolated contralateral neck failure.
  
  
  RESULTS
  Of 481 patients, 14 (2.9%) developed isolated contralateral neck recurrence, with median time to recurrence of 8 months. Patients with poorly differentiated tumours or pathologically proven ipsilateral nodal metastases were at significantly higher risk of contralateral failure (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.1-11.9, P = 0.037 and HR 4.6, 95% CI 1.5-13.8, P = 0.006 respectively). Presence of both of these factors conferred a 10% risk of contralateral failure.
  
  
  CONCLUSIONS
  Patients with lateralized oral SCC undergoing treatment of the primary tumour and ipsilateral neck have a low rate of isolated contralateral neck failure. Although poorly differentiated primaries and ipsilateral nodal metastases were predictors of contralateral recurrence, the risk remains relatively modest in this subset of patients suggesting close observation may be more appropriate than elective treatment. Our results support current recommendations for observation of the cN0 contralateral neck in lateralized oral SCC.
authors.affiliation: Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: Miriam
authors.initials: M
authors.lastname: Habib
authors.affiliation: Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: Jothi
authors.initials: J
authors.lastname: Murgasen
authors.affiliation: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Kan
authors.initials: K
authors.lastname: Gao
authors.affiliation: Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.|Department of Head and Neck Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ashford
authors.affiliation: Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Kerwin
authors.initials: K
authors.lastname: Shannon
authors.affiliation: Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.|Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ardalan
authors.initials: A
authors.lastname: Ebrahimi
authors.affiliation: Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.|Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.|Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000628:therapy*; D037981:Neck Dissection / Q000379:methods; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D055815:Young Adult
keywords: contralateral neck metastasis; lymph nodes; neck dissection; oral cancer