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

## TL;DR

This study finds that early-stage HPV-related tongue base cancer patients rarely have hidden cancer spread to the opposite neck, suggesting that treating the opposite neck may not be necessary.

## Contribution

The study provides new evidence on the low risk of occult contralateral metastasis in HPV+ base-of-tongue cancer patients after primary surgery.

## Key findings

- No cases of occult contralateral neck metastasis were identified in 106 patients.
- Survival and recurrence rates did not significantly differ between patients who received and did not receive contralateral neck treatment.

## Abstract

(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.

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.

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.

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.

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.