Omitting postoperative radiotherapy to the contralateral pathologically node-negative neck appears to be safe in oropharyngeal squamous cell carcinoma

Background There are currently no guidelines for adjuvant radiotherapy of the contralateral pathologically node-negative neck in squamous oropharyngeal carcinoma. The aim of this study was to determine whether omission of contralateral radiotherapy affects oncologic outcome. In addition, we aimed to determine factors that precisely lead to postoperative irradiation of the contralateral pathologically negative neck.

Methods We retrospectively identified 96 patients with primary surgical treatment and postoperative (chemo)radiotherapy (PO(C)RT). Survival was analyzed using the log-rank test and the Kaplan-Meier method. Multiple logistic regression analysis was used to determine the factors contributing to PO(C)RT of the contralateral pathologically node-negative neck.

Results Patients showed no worsening of tumor-free, cause-specific, or overall survival (OS) when PO(C)RT of the contralateral pathologically node-negative neck was omitted. Increased OS was seen with unilateral PO(C)RT and tumors arising from lymphoepithelial tissue. There was an increased likelihood of bilateral PORT with the need for CRT.

Conclusions Omission of adjuvant radiotherapy of the contralateral pathologically negative neck is oncologically justifiable. The presence of high-risk criteria (positive margins and/or extranodal extension) is more likely to lead to an indication for bilateral adjuvant irradiation of the cervical lymphatic drainage pathways without a survival benefit.

Publication History

Article published online:
12 May 2023