Contralateral Neck Metastases in Lateralised, Resectable Advanced Stage Oropharyngeal Squamous Cell Carcinoma – results of 57 patients undergoing bilateral selective neck dissection

Abstract

This series demonstrates unique data assessing the surgical staging of the cN0 contralateral neck in lateralised oropharyngeal squamous cell carcinoma.

Only 5 out of 57 patients were found to have occult nodal metastases. The rate appears higher in HPV negative disease (3/5 patients) than HPV positive patients (2/52 patients)

This multi–departmental policy in the management of resectable oropharyngeal squamous cell carcinoma led to the reduction of adjuvant radiotherapy field in 52 patients, and appropriate intensification of adjuvant therapy in 5 patients.

The contralateral neck in these patients needs managing or staging, if avoidance of prophylactic radiotherapy is deemed desirable. Surgical staging seems appropriate, but given the low incidence of occult metastases, other options would include pre-operative ¹⁸F-FDG PET/CT staging, serial imaging, sentinel lymph node biopsy, or delivery of adjuvant treatment unilaterally following routine staging imaging.

Decisions on which approach is most appropriate should be made by individual MDT's whilst consensus is lacking.

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