방사선의학 웹진

바로가기  >

Figure 1. Comparison of the 5-year overall survival (OS) (A), disease-free survival (DFS) (B), locoregional relapse-free survival (LRRFS) (C), and distant metastasis-free survival (DMFS) (D) rates between the ipsilateral neck radiotherapy (INRT) and bilateral neck radiotherapy (BNRT) groups defined by propensity-score matching.

​

Abstract

PURPOSE:

The impact of postoperative ipsilateral neck radiotherapy (INRT) versus bilateral neck radiotherapy (BNRT) on the clinical outcomes of patients with tonsillar squamous cell carcinoma was analyzed retrospectively.

MATERIALS AND METHODS:

Between October 2001 and June 2012, 241 patients with T1-2 and N0-N2b tonsillar carcinoma from 16 institutes underwent postoperative INRT (n=84) or BNRT (n=157) following a tonsillectomy. Seventy patients were identified from each group by propensity score matching and compared in terms of the overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates calculated using the Kaplan-Meier method with a log-rank test.

RESULTS:

The median follow-up was 55 months (range, 3 to 133 months). The survival outcomes in the INRT and BNRT groups were similar: 5-year OS (92.8% vs. 94.0%, p=0.985), DFS (80.5% vs. 94.2%. p=0.085), LRRFS (88.1% vs. 97.1%, p=0.083), and DMFS (92.7% vs. 97.0%, p=0.370). Subgroup analysis revealed no contralateral neck recurrence in 61 patients with T1-2N0-2a regardless of the treatment groups. For 79 patients with N2b, contralateral neck recurrence was more common in the INRT group than in the BNRT group (7.9% vs. 0.0%), but the difference was not significant (p=0.107). The overall grade ≥ 2 toxicities were lower in the INRT group: acute (45.7% vs. 74.3%, p=0.001) and late (4.3% vs. 31.4%, p < 0.001), respectively.

CONCLUSION:

INRT is an attractive strategy for patients with T1-2N0-2a tonsillar carcinoma compared to BNRT. For patients with N2b, there was a small risk of contralateral neck recurrence when treated with INRT, but its impact on the OS was limited with successful salvage treatment.

Author information

Kim Y1, Cho KH1, Moon SH1, Lee CG2, Keum KC2, Lee SW3, Ahn YC4, Oh D4, Kim YS5, Won YK5, Wu HG6, Hah JH7, Oh YT8.

1 Proton Therapy Center, National Cancer Center, Goyang, Korea.

2 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.

3 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

4 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

5 Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

6 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

7 Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.

8 Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.