Management of the neck in node-positive tonsillar cancer

Abstract

Conclusion: Neck dissection (ND) may not be warranted for those patients with complete response in the neck. Human papillomavirus (HPV)-positive or -negative tumour does not affect this recommendation. Objectives: Treatment of tonsillar cancer varies considerably worldwide, although non-surgical treatment, e.g. radiotherapy (RT), possibly combined with chemotherapy (CRT), is gradually coming to be regarded as the first line of therapy. However, the optimal treatment of nodal disease remains controversial, and the fundamental question is if and when to perform ND. Methods: We performed a retrospective analysis of all patients with tonsillar cancer treated in the Stockholm area between 2000 and 2006. An analysis of node-positive tumours was done and the neck specimen was investigated for the presence of viable tumour cells after RT. A sub-analysis of HPV status was also carried out. Results: Following complete response after RT, 2% of patients showed viable cells in the neck specimen, compared with 60% in patients who did not show complete response. HPV-positive tumours had the same proportion of viable tumour cells in the neck specimen as HPV-negative tumours.

Keywords::

• Neck dissection
• HPV
• radiotherapy

Acknowledgments

The Swedish Cancer Foundation, the Stockholm Cancer Society, the Swedish Research Council, the Laryngeal Foundation and Acta Otolaryngologica.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.