Risk of Occult Contralateral Neck Metastasis in Early-Stage HPV-Related Lateralized Cancer of the Base of the Tongue

Tyler R Halle; Austin C Cao; Anusha G Naik; Gregory S Weinstein; Jake J Lee; Theodore A Gobillot; Erin R Kaye; Robert M Brody; Devraj Basu; Bert W O'Malley Jr; D Gregory Farwell; Steven B Cannady; Alexander Lin; John Lukens; Michelle Gentile; Jason G Newman; Ara A Chalian; Christopher H Rasskeh; Karthik Rajasekaran

doi:10.1002/hed.70117

Risk of Occult Contralateral Neck Metastasis in Early-Stage HPV-Related Lateralized Cancer of the Base of the Tongue

Head Neck. 2025 Dec 10. doi: 10.1002/hed.70117. Online ahead of print.

Authors

Tyler R Halle¹, Austin C Cao², Anusha G Naik², Gregory S Weinstein², Jake J Lee³, Theodore A Gobillot², Erin R Kaye⁴, Robert M Brody^{1

2}, Devraj Basu², Bert W O'Malley Jr⁵, D Gregory Farwell², Steven B Cannady², Alexander Lin⁶, John Lukens⁶, Michelle Gentile⁶, Jason G Newman⁷, Ara A Chalian², Christopher H Rasskeh², Karthik Rajasekaran^{2

8}

Affiliations

¹ Department of Otolaryngology, Emory University, Atlanta, Georgia, USA.
² Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Department of Otolaryngology-Head & Neck Surgery, Stanford Medicine, Stanford, California, USA.
⁴ Department of Otolaryngology, University of Miami, Miami, Florida, USA.
⁵ Department of Otolaryngology, University of Maryland, Baltimore, Maryland, USA.
⁶ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁷ Department of Otolaryngology, Medical Univesity of South Carolina, Charleston, South Carolina, USA.
⁸ Leonard Davis Institute of Health Economics, University of Pennsylvania, Pennsylvania, USA.

PMID: 41367328
DOI: 10.1002/hed.70117

Abstract

Objectives: (1) To determine the incidence of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated base-of-tongue (BOT) oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery; and (2) to compare survival and recurrence in patients who did and did not undergo contralateral neck treatment.

Background: Contralateral neck management in patients with early-stage HPV+ OPSCC of the BOT treated surgically remains controversial. Despite lacking data, most patients receive surgery and/or radiation to the contralateral neck based on historical incidence of occult lymph node metastasis in OPSCC.

Methods: A retrospective chart review of patients with AJCC 7th edition pT1-2, pN0-1 HPV+ BOT OPSCC undergoing transoral robotic BOT resection and ipsilateral neck dissection with adjuvant treatment was conducted. The incidence of occult contralateral nodal metastasis was assessed. Overall and disease-free survival were compared between patients who did and did not undergo contralateral neck treatment.

Results: Of 106 patients meeting inclusion criteria, 46 (43.3%) did not undergo treatment of the contralateral neck with radiation or lymphadenectomy, whereas 29 (27.4%) received radiation alone to the contralateral neck, and 31 (29.2%) underwent elective contralateral neck dissection without identification of occult metastasis in any case. Overall survival (HR: 0.95, 95% CI: 0.23-4.00) and disease-free survival (HR: 1.43, CI: 0.55-3.71) did not significantly differ between patients who did and did not receive treatment to the contralateral neck.

Conclusion: Risk of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated BOT OPSCC treated with primary surgery was low, prompting consideration of forgoing contralateral neck treatment in these patients.

Keywords: HPV‐related oropharyngeal squamous cell carcinoma; base‐of‐tongue; cervical lymph node metastasis; transoral robotic surgery.