Criteria for Bilateral versus Ipsilateral (1 side only) neck radiation

CaptZ

What are others experiences and knowledge here? Most trials and articles now support ipsilateral neck radiation recommendation (HPV+ context) when positive nodes are only found on 1 side. Why are many centers still treating both sides of neck as protocol? Is lymph node size a factor or other additional criteria? Bilateral versus ipsilateral impacts QOL significantly, do many feel they were given a proper choice or had option for ipsilateral?

ProustLover

My husband was in this

My husband was in this situation, with the cancerous nodes on one "low-lying" level.  I believe it was level 4, towards his chest.  He was told that the odds of a cancerous cell "migrating" to the other side had to be considered, especially at the low-lying level.  It was described as "increased risk of microscopic disease."  He struggled with the decision,  but fnally agreed to both sides.  We try not to dwell on the past, but that decision was made quickly, without a lot of hard facts from the docs.  The amount of radiation was reduced because it was HPV+.

I should include that his case had metastasized from his tongue, involved multiple lymph nodes on one side, and was stage IV.  It seemed like a case of better safe than sorry.  It's been 3 years now, and so far, so good,. 

wbcgaruss

ProustLover said:

My husband was in this

My husband was in this situation, with the cancerous nodes on one "low-lying" level.  I believe it was level 4, towards his chest.  He was told that the odds of a cancerous cell "migrating" to the other side had to be considered, especially at the low-lying level.  It was described as "increased risk of microscopic disease."  He struggled with the decision,  but fnally agreed to both sides.  We try not to dwell on the past, but that decision was made quickly, without a lot of hard facts from the docs.  The amount of radiation was reduced because it was HPV+.

I should include that his case had metastasized from his tongue, involved multiple lymph nodes on one side, and was stage IV.  It seemed like a case of better safe than sorry.  It's been 3 years now, and so far, so good,. 

ProustLover Thanks For

The explanation because I was completely confused. I am glad to celebrate with you that your husband is still clear after 3 years. He certainly went through a lot and did you also as a caregiver. Take Care-God Bless-Russ

ProustLover

Greetings, Russ!

Hi, Russ - always good to hear from you!  After responding to CaptZ, I checked my old notes further, and recalled that the radiation doc had referred us to the NCCN guidelines and algorithms.  Maybe those guidelines have changed in 3 years, or maybe the guidelines don't change based on trials and articles, until there is more preponderance of the evidence.  In any case, at the time, the radiation doc cited a "15-20%" chance of microscopic disease in the other side of the neck.  The guidelines do factor in all the criteria of the specific case, so it isn't a one size fits all.  There are a number of folks on this forum who have opted for ipsilateral radiation, and are glad for their decision.  Other folks say "throw the kitchen sink at it."  It's a tough call for CaptZ and anyone facing it.  Once you make it, it's best not to dwell.  Take care, Russ...hang in there!  

johnsonbl

I think the NCCN guidelines are pretty clear on....

Whether to do 1 or both sides.  Long story short if they consider you high risk you may end up getting both sides....  I think the most common reason is location of your primary and whether the lymphatic system from that location extends to both sides of your neck.  If your tumor is closer to the middle of your head (midline) than on one side then you will likely get both sides done (maybe even bilateral neck dissection).  If you show signs of poor margins or extranodal extension (aggressive tumor) then you might get both sides. 

If your cancer team is multidisciplinary and your case is reviewed by a tumor board you can likely feel pretty good about your plan being in line with the latest and greatest.  If you are in a system where all the parts of your care are fractured and provided by un-connected groups you may be at higher risk of not getting the exact right treatment.

skidog

I had Proton Therapy

on just the left side for early stage tonsil and one lymph node just under my jaw. Got 3 opinions. UW cancer center, Northwestern hospital and Mayo. I went with Mayo because they felt positive proton beam rads only on left side would produce very good success rate for my specific cancer.  (95+%). Im not a fan of Chemo...but thats just me. Had to go thru some hoops to get Insurance to cover it...but we appealed and got them to cover in full (minus the $10k deductable) good luck with your plan. You have choices. But we are all different and its important to do your reseach and feel good about your decision and have confidence in your care team.

CaptZ

Some Treatment Regrets - so important to research all aspects

Some really good comments here. I had TLM for left tonsil removal (T2) and neck dissection for 2 positive lymph nodes on left side, 1 being 4.3 cm but no ENE. Tonsil margins were clean but 1 close. I recieved bilateral radiation as they told me "better to address now IN CASE there was anything on right side". I really questioned this at first, but it didn't feel like a choice at the time and I was still in "cancer" shock. I had 50 gry to left side and tonsil base, 46 gry to right side. VMAT (rapid arc form of IMRT) left me red all around neck from clavicle to jaw and skin is still tanned. I initially thought I was fortunate as no chemo and reduced from 60 gry at my request but now feel I got way too much for how other centers treat HPV+ early tonsil cancer. No time machine but more research would have led me to either bypass radiation for wait and see or just do upper neck right side. I have learned far more from sites like this after the fact than information given during treatment.