Risk of Occult Contralateral Neck Metastasis in Early‐Stage HPV ‐Related Lateralized Cancer of the Base of the Tongue

Objectives (1) To determine the incidence of occult contralateral cervical lymph node metastasis in patients with early‐stage HPV‐associated base‐of‐tongue (BOT) oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery; and (2) to compare survival and recurrence in patients who did and did not undergo contralateral neck treatment. Background Contralateral neck management in patients with early‐stage HPV+ OPSCC of the BOT treated surgically remains controversial. Despite lacking data, most patients receive surgery and/or radiation to the contralateral neck based on historical incidence of occult lymph node metastasis in OPSCC. Methods A retrospective chart review of patients with AJCC 7th edition pT1‐2, pN0‐1 HPV+ BOT OPSCC undergoing transoral robotic BOT resection and ipsilateral neck dissection with adjuvant treatment was conducted. The incidence of occult contralateral nodal metastasis was assessed. Overall and disease‐free survival were compared between patients who did and did not undergo contralateral neck treatment. Results Of 106 patients meeting inclusion criteria, 46 (43.3%) did not undergo treatment of the contralateral neck with radiation or lymphadenectomy, whereas 29 (27.4%) received radiation alone to the contralateral neck, and 31 (29.2%) underwent elective contralateral neck dissection without identification of occult metastasis in any case. Overall survival (HR: 0.95, 95% CI: 0.23–4.00) and disease‐free survival (HR: 1.43, CI: 0.55–3.71) did not significantly differ between patients who did and did not receive treatment to the contralateral neck. Conclusion Risk of occult contralateral cervical lymph node metastasis in patients with early‐stage HPV‐associated BOT OPSCC treated with primary surgery was low, prompting consideration of forgoing contralateral neck treatment in these patients.