Unilateral radiation leads to fewer contralateral nodal failure in AJCC-7 T1-2N2b tonsillar cancer

Treatment with unilateral radiation for American Joint Committee on Cancer (AJCC)-7 T1-2N2b tonsillar cancer is associated with low rates of contralateral nodal failure, a recent study has shown.

“Unilateral radiation to cervical nodes has been used as a de-escalation strategy in well-lateralized tonsil cancers,” the authors said. “The study hypothesis was that unilateral radiation for AJCC-7 T1-2N2b tonsillar cancer results in a low rate of contralateral nodal failure.”

A retrospective chart review was carried out on patients with AJCC-7 T1-2N2b tonsillar cancer from two academic institutions who were treated with unilateral radiation to test the hypothesis. Contralateral nodal failure rate was the primary endpoint, while secondary ones included locoregional control, overall survival, and the need for gastrostomy tube placement.

Overall, 66 patients treated between 2005 and 2016 were included in this study. The median follow-up time was 80.9 months. Of the patients, two (3.0 percent) had contralateral nodal failure at 4.1 and 20.9 months, respectively. Both of them went through salvage treatment with long-term subsequent survival.

Overall locoregional control was 93.3 percent at both 2 and 5 years, while the median duration of control was not reached. In addition, overall survival was 92.4 percent at 5 years.

“This outcome demonstrates the safety of considering unilateral radiation treatment in patients with a relatively high ipsilateral nodal burden,” the authors said.