Niema B Razavian,Joshua D Waltonen,Cole R Steber,Rachel F Shenker,Nelson H May,Jae H Yang,Claire M Lanier,Kathryn M Greven,Bart A Frizzell,Ryan T Hughes
INTRODUCTIONStrategies for treatment of tonsil carcinoma are under active investigation. Limiting surgical and radiation treatment volumes to the primary tumor and ipsilateral neck in appropriately selected patients is one such approach. Here, we present our institutional experience with treatment through ipsilateral surgical or radiotherapeutic neck management.METHODSWe retrospectively reviewed our institutional database of patients with tonsil carcinoma treated from 2012 to 2020. Patients were included for analysis if they received definitive radiation therapy (RT), definitive surgery (S), or surgery with post-operative radiation therapy (S-PORT) and whose treatment volumes were limited to the primary tumor and involved/elective ipsilateral neck. Patients who received radiation and/or surgery to the contralateral neck (including those with bilateral nodal involvement), as well as patients with metastatic disease, were excluded. Clinical factors including T- and N-stage (AJCC 7th edition), and HPV status (by p16 and/or HPV DNA PCR) were recorded, as were pathologic factors (when applicable) including margin status, extracapsular extension (ECE), lymphovascular invasion (LVSI), and perineural invasion (PNI). Overall survival (OS), progression free survival (PFS), and locoregional control (LRC) at 2 years were estimated using the Kaplan-Meier method.RESULTSIn total, 71 patients were treated with unilateral neck approaches: S (n=49), RT (n=10), and S+PORT (n=12). Among these patients, 32, 36, and 3 had T1, T2, and T3 disease, respectively. N-stage was N0, N1, N2a, N2b, and N3 in 22, 20, 5, 23, and 1 patient(s), respectively. Concurrent chemotherapy was administered in 12 patients. From those with recorded risk factors, 86% were HPV-positive, 20% had LVSI, 7% had PNI, 13% had ECE, and 5% had positive margins. From a median follow-up of 27 months, local, regional, and distant failures occurred in 5, 6, and 5 patients, respectively. No contralateral neck failures were recorded. At 2 years, OS, PFS, and LRC were 92% (95% CI 85-99%), 85% (95% CI 75-95%), and 88% (95% CI 80-98%), respectively.CONCLUSIONSIn patients with early T-stage tonsil carcinoma, treatment of the primary tumor and ipsilateral neck is associated with acceptable OS, PFS, and LRC. In this population, the risk of contralateral neck failure is likely very low regardless of primary treatment modality. Additional prospective studies are needed to determine the impact of limiting treatment extent to the unilateral neck.
扁桃体癌的治疗策略正在积极研究中。在适当选择的患者中，将手术和放射治疗范围限制在原发肿瘤和同侧颈部是其中一种方法。在此，我们介绍了本院通过同侧手术或放射治疗颈部的治疗经验。方法我们回顾性地查看了本院数据库中 2012 年至 2020 年接受治疗的扁桃体癌患者。如果患者接受了确定性放疗（RT）、确定性手术（S）或术后放疗手术（S-PORT），且治疗范围仅限于原发肿瘤和受累/选择性同侧颈部，则纳入分析范围。对侧颈部接受放射治疗和/或手术的患者（包括双侧结节受累的患者）以及转移性疾病患者均被排除在外。临床因素包括T期和N期（AJCC第7版）、HPV状态（通过p16和/或HPV DNA PCR），病理因素（如适用）包括边缘状态、囊外扩展（ECE）、淋巴管侵犯（LVSI）和神经周围侵犯（PNI）。采用 Kaplan-Meier 法估算了 2 年的总生存期（OS）、无进展生存期（PFS）和局部区域控制率（LRC）：S（49例）、RT（10例）和S+PORT（12例）。在这些患者中，T1、T2 和 T3 疾病患者分别为 32 人、36 人和 3 人。N分期为N0、N1、N2a、N2b和N3的患者分别有22人、20人、5人、23人和1人。12名患者同时接受了化疗。在有风险因素记录的患者中，86%为HPV阳性，20%为LVSI，7%为PNI，13%为ECE，5%为边缘阳性。在 27 个月的中位随访中，分别有 5、6 和 5 名患者出现局部、区域和远处失败。没有对侧颈部手术失败的记录。2年后，OS、PFS和LRC分别为92%（95% CI 85-99%）、85%（95% CI 75-95%）和88%（95% CI 80-98%）。在这一人群中，无论采用哪种主要治疗方式，对侧颈部失败的风险可能都很低。需要进行更多的前瞻性研究，以确定将治疗范围限制在单侧颈部的影响。
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