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Rise in bilateral neck disease likely caused by increase in tonsillar cancer
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The incidence of advanced neck disease in small primary tonsil cancer increased during the past 2 decades, but the trend appears to be due to the rising rate of tonsillar cancer, rather than a new biologic behavior, according to study findings published in the journal Head & Neck.
Thomas J. Galloway, MD, of the department of radiation oncology at Fox Chase Cancer Center in Philadelphia, and colleagues reviewed the SEER database data from 1988 to 2008 to determine whether bilateral neck disease in tonsillar cancer has become more common as the proportion of HPV-associated cancers has increased.
The researchers divided the study period into two intervals because of a SEER database coding change that occurred from 2003 to 2004.
The researchers’ review showed the incidence of small primary tonsillar cancer without regional disease — classified as T1-T2N0 — remained relatively stable during the study period, with no annual percentage change from 1988 to 2003 and a 3.6% annual percentage change from 2004 to 2008.
“The cumulative increase over decades signifies that tonsillar cancer with advanced regional node disease is twice as common as it was fewer than 25 years ago,” the researchers wrote. “Analysis confined to small primary tonsil tumors with advanced node metastases demonstrates that their current incidence is three to four times that of 1988.”
The incidence of small primary tonsillar cancer with advanced ipsilateral regional disease increased 7% annually from 1988 to 2003 and 10.6% annually from 2004 to 2008 (P<.05), the researchers said. The incidence of small primary tonsillar cancer with bilateral regional disease increased 6.9% annually from 1988 to 2003 and 5.9% annually from 2004 to 2008 (P<.05).
Small primary tonsillar cancers with bilateral neck nodes remain relatively rare, and their change in incidence was not statistically significant, according to the researchers.
The increase in bilateral neck disease is less than the overall rise in T1 to T2 tonsillar cancer, which increased 7.2% per year from 2004 to 2008 (P<.05).
“This analysis of available population-based data supports the previously validated finding that small primary, lateralized tonsillar cancer is rarely associated with contralateral adenopathy. While contralateral adenopathy in small primary tonsillar cancer is increasing in prevalence, it seems to be a consequence of the rising rate of tonsillar cancer rather than a special feature of HPV-related tumors,” the researchers wrote. “Because the incidence of bilateral neck nodal disease is not increasing at a disproportionate rate from that of 20 years ago, adopting a policy of bilateral neck radiation in all patients with tonsillar cancer in the era of HPV-related cancers does not seem justified.”
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