Unilateral vs bilateral neck irradiation: The importance of careful patient selection in tailoring radiation therapy for lateralized palatine-tonsil and non-palatine-tonsil oropharyngeal carcinoma

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-07-19 DOI:10.1016/j.radonc.2025.111049

Max Gau , Fatimah A. Alfaraj , Shao Hui Huang , Brian O’Sullivan , Jie Su , Wei Xu , Sarah N. Hamilton , Anthony Maletta , Omar Salman , Mary McInerney , Abiha Javed , Enrique Sanz-Garcia , Scott Bratman , Ezra Hahn , Andrew Hope , John J. Kim , Nauman Malik , Andrew McPartlin , C. Jillian Tsai , John Waldron , Ali Hosni

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引用次数: 0

Abstract

Title

Unilateral vs Bilateral Neck Irradiation: The Importance of Careful Patient Selection in Tailoring Radiation Therapy for Lateralized Palatine-Tonsil and Non-Palatine-Tonsil Oropharyngeal Carcinoma.

Purpose

To compare oncologic outcomes of well-lateralized oropharyngeal carcinoma (OPC) following unilateral vs bilateral neck radiotherapy (RT).

Methods

Patients with cT1-3 N0-2bM0 (TNM-7) OPC, treated with curative (chemo)RT in two institutions (2008–2019) were identified. For palatine tonsil tumor, unilateral neck RT was considered for tumor not invading beyond 1 cm of the tongue base or the soft palate without deep penetration. Unilateral neck RT was also considered for well-lateralized non-palatine tonsil tumor (i.e. base of tongue, soft palate or vallecula) within 1 cm of the lateral part of the mucosal corresponding oropharyngeal subsite without deep penetration. One-to-one propensity score-matched cohort of patients treated with unilateral vs bilateral neck RT was created according to patient, tumor, and treatment characteristics. The primary outcome was contralateral-only nodal failure (CNF, i.e., without local or ipsilateral regional failure). Secondary outcomes included local failure (LF), regional failure (RF), distant metastasis (DM), disease-free survival (DFS) and overall survival (OS).

Results

346 patients were selected for the matched cohort (173 in each group), including 46 non-palatine tonsil tumors. The median follow-up was 5.1 years. The 5-year CNF, LF, RF, DM, DFS and OS for unilateral vs bilateral neck RT groups were 1 % (95 % CI: 0 %-3%) vs 0 %, 5 % (95 % CI: 3 %-10 %) vs 2 % (95 % CI: 0 %-5%), 4 % (95 % CI: 2 %-8%) vs 4 % (95 % CI: 2 %-8%), 5 % (95 % CI: 3 %-10 %) vs 6 % (95 % CI: 3 %-10 %), 80 % (95 % CI: 74 %-87 %) vs 79 % (95 % CI: 73 %-86 %), and 85 % (95 % CI: 80 %-91 %) vs 83 % (95 % CI: 78 %-90 %), respectively (p > 0.05 for all). One patient in the unilateral neck RT group had CNF after RT (cT2N2bM0 tonsillar cancer, successfully salvaged).

Conclusion

Careful selection of well-lateralized OPC to receive unilateral neck RT results in favourable oncologic outcomes.

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单侧与双侧颈部放疗：对偏侧腭扁桃体和非腭扁桃体口咽癌进行个体化放疗时谨慎选择患者的重要性

题目：单侧与双侧颈部放疗：对偏侧腭扁桃体和非腭扁桃体口咽癌进行个体化放疗时谨慎选择患者的重要性。目的比较单侧和双侧颈部放射治疗后良好侧化口咽癌（OPC）的肿瘤预后。方法选取2008-2019年在两家机构接受治疗性（化疗）RT治疗的cT1-3 N0-2bM0 (TNM-7) OPC患者。对于腭扁桃体肿瘤，考虑单侧颈部RT，肿瘤浸润不超过舌根1 cm或软腭未深穿透。单侧颈部RT也可用于距口咽亚位相应粘膜外侧1 cm以内的非腭扁桃体肿瘤（即舌底、软腭或小囊），但未深穿。根据患者、肿瘤和治疗特点，建立单侧和双侧颈部RT治疗患者的一对一倾向评分匹配队列。主要结果是仅对侧淋巴结失败（CNF，即没有局部或同侧区域失败）。次要结局包括局部失败（LF）、区域失败（RF）、远处转移（DM）、无病生存期（DFS）和总生存期（OS）。结果346例患者入选匹配队列（每组173例），其中非腭扁桃体肿瘤患者46例。中位随访时间为5.1年。5年CNF,低频射频,DM, DFS和OS单边和双边颈RT组1% (95% CI: 0% - -3%)与0%,5% (95% CI: 3% - -10%)和2% (95% CI: 0% - -5%), 4% (95% CI: 2% - -8%)和4% (95% CI: 2% - -8%), 5% (95% CI: 3% - -10%)和6% (95% CI: 3% - -10%), 80% (95% CI: 74% - -87%)和79% (95% CI: 73% - -86%)和85% (95% CI: 80% - -91%)和83% (95% CI: 78% - -90%),分别为(p比;0.05)。单侧颈部放疗组1例患者术后出现CNF （cT2N2bM0扁桃体癌，成功抢救）。结论谨慎选择侧位良好的OPC接受单侧颈部RT治疗可获得良好的肿瘤预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.