Clinical nodal staging of T1-2 tonsillar squamous cell carcinoma stratified by p16 status and implications for ipsilateral neck irradiation
Shoushtari AN, Meeneghan M, Treharne GC, Reibel JF, Levine PA, Moskaluk CA, Jameson MJ, Read PW. Departments of Radiation Oncology, University of Virginia, Charlottesville, VA 22903, USA. Cancer J. 2010 May-Jun;16(3):284-7.
BACKGROUND AND PURPOSE: Previous studies have reported <5% incidence of contralateral nodal metastasis in patients with T1-2 tonsillar squamous cell carcinoma. We analyzed the nodal staging of T1-2 tonsillar squamous cell carcinoma stratified for p16 status, a marker of human papillomavirus positivity.
MATERIALS AND METHODS: Clinical and radiographic nodal staging and p16 status of 41 T1-2 tonsillar squamous cell carcinoma patients who were treated between January 2002 and June 2009 were retrospectively analyzed. Patients with a history of prior head and neck cancer, synchronous cancers, base of tongue or soft palate invasion, or distant metastases at diagnosis were excluded.
RESULTS: Of the 41 patients, 28 (68.2%) had p16+ tumors and 13 (31.7%) had p16- tumors. Seven patients (17.0%) presented with contralateral cervical nodal disease, all of whom had p16+ tumors. Furthermore, 25.0% of patients with p16+ tumors presented with contralateral cervical nodal disease compared with 0% of patients with p16- tumors.
CONCLUSIONS: Patients with p16+ T1-2 tonsillar squamous cell carcinoma present with a higher incidence of contralateral nodal spread than those patients with p16- disease. This may have clinical implications when determining which patients are good candidates for ipsilateral cervical nodal irradiation.
PMID: 20526108 [PubMed – indexed for MEDLINE]