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편도 편평세포암종의 반대측 N0 경부치료

Other Titles
 Management of Contralateral N0 Neck in Tonsillar Squamous Cell Carcinomas 
 임영창  ;  이세영  ;  임재열  ;  안재윤  ;  서형석  ;  최영춘  ;  이진석  ;  구본석  ;  최은창 
 Korean Journal of Otolaryngology (대한이비인후과학회지), Vol.48(5) : 660-664, 2005 
Journal Title
Korean Journal of Otolaryngology(대한이비인후과학회지)
Issue Date
Tonsillar neoplasm ; Lymphatic metastasis ; Neck dissection
Tonsillar neoplasm ; Lymphatic metastasis ; Neck dissection
Background and Objectives:It is well established that tonsillar squamous cell carcinoma has high probability to be disseminated to the neck. An ipsilateral neck treatment is mandatory during initial treatment stages of II-IV tonsillar carcinomas. However, no consensus exists as to whether an elective contralateral neck management should be performed.

Subjects and Method:A retrospective analysis was performed on 43 N1-3 tonsillar cancer patients with contralateral negative necks who were treated between 1992 to 2002. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 months (mean, 38 months). The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis.

Results:Clinically occult, but pathologically positive contralateral lymph nodes were found in 16% (7 of 43). In cases of ipsilateral N (+) neck, contralateral occult lymph node metastases developed in 21% (7 of 33) and there was no incidence of that in the cases of ipsilateral N0 necks. Based on the clinical stages of the tumor, 5% (1 of 22) of the cases metastatically involved ymph nodes in the T2 tumors, 36% (5 of 14) in the T3, and 25% (1 of 4) in the T4. T1 tumors (3 cases) had no pathologically positive lymph nodes (T1+T2 vs T3+T4, p<.05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific free survival rates over patients with any pathologically positive nodes (5 year disease specific survival rate, 92% vs 28%, p=<.05).

Conclusion:The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high and patients who presented with contralateral metastatic neck have worse prognosis than those who are staged as N0. Therefore, we advocate a routine bilateral neck dissection in tonsillar squamous cell carcinoma patients with unilateral node metastases.
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1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
Yonsei Authors
Koo, Bon Seok(구본석)
Lee, Sei Young(이세영)
Lee, Jin Seok(이진석)
Lim, Jae Yol(임재열) ORCID logo https://orcid.org/0000-0002-9757-6414
Choi, Eun Chang(최은창)
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