Defining high-risk elective contralateral neck radiation volumes for oropharynx cancer

Matthew E Witek; Neil M Woody; Hima B Musunuru; Patrick M Hill; Poonam Yadav; Adam R Burr; Huaising C Ko; Richard B Ross; Randall J Kimple; Paul M Harari

doi:10.1002/hed.26924

Defining high-risk elective contralateral neck radiation volumes for oropharynx cancer

Head Neck. 2022 Feb;44(2):317-324. doi: 10.1002/hed.26924. Epub 2021 Nov 11.

Authors

Affiliations

¹ Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, Wisconsin, USA.
² Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA.
³ Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.
⁵ Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.

Abstract

Background: To define the location of the initial contralateral lymph node (LN) metastasis in patients with oropharynx cancer.

Methods: The location of the LN centroids from patients with oropharynx cancer and a single radiographically positive contralateral LN was defined. A clinical target volume (CTV) inclusive of all LN centroids was created, and its impact on dose to organs at risk was assessed.

Results: We identified 55 patients of which 49/55 had a single contralateral LN in level IIA, 4/55 in level III, 1/55 in level IIB, and 1/55 in the retropharynx. Mean radiation dose to the contralateral parotid gland was 15.1 and 21.0 Gy, (p <0.001) using the modeled high-risk elective CTV and a consensus CTV, respectively.

Conclusions: We present a systematic approach for identifying the contralateral nodal regions at highest risk of harboring subclinical disease in patients with oropharynx cancer that warrants prospective clinical study.

Keywords: elective; lymph nodes; oropharynx cancer; radiotherapy; toxicity.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Humans
Lymph Nodes / diagnostic imaging
Lymph Nodes / pathology
Oropharyngeal Neoplasms* / diagnostic imaging
Oropharyngeal Neoplasms* / pathology
Oropharyngeal Neoplasms* / radiotherapy
Parotid Gland
Prospective Studies
Radiotherapy Dosage
Radiotherapy, Conformal*

Grants and funding

P50 DE026787/DE/NIDCR NIH HHS/United States