Is there a patient population with squamous cell carcinoma of the head and neck region who might benefit from de-intensification of postoperative radiotherapy?

A monocentric retrospective analysis of a previously defined low-risk patient population treated with standard-of-care radiotherapy
  • Yonca Onbasi
  • Sebastian Lettmaier
  • Markus Hecht
  • Sabine Semrau
  • Heinrich Iro
  • Marco Kesting
  • Rainer Fietkau
  • Marlen HaderleinEmail author
Original Article



The aim of this retrospective study was to evaluate the clinical outcome of a previously defined low-risk patient population with completely resected (R0) squamous cell carcinoma of the oral cavity, oropharynx, larynx (pT1–3, pN0–pN2b), hypopharynx (pT1–2, pN0–pN1), and the indication for postoperative radio(chemo)therapy.

Patients and methods

According to predefined criteria, 99 patients with head and neck squamous cell carcinoma (SCC) who were treated at our institution from January 1, 2005 to December 31, 2014, were available for analysis. The Kaplan–Meier method was used for calculating survival and incidence rates. For univariate comparative analysis, the log-rank test was used for analyzing prognostic clinicopathologic parameters.


Median follow-up was 67 months. Cumulative overall (OS) and disease-free survival (DFS) were 97.9%/94.7%/88.0% and 96.9%/92.6%/84.7% after 1, 2, and 5 years, respectively. Cumulative incidence of loco-regional recurrence (LRR), distant metastases (DM), and second cancer (SC) were 1.0%/1.0%/4.9%, 0.0%/3.4%/5.8%, and 2.1%/4.2%/13.1%, respectively. In univariate comparative analysis, location of the primary tumor in the oropharynx was a significant predictor for increased OS (p = 0.043) and DFS (p = 0.048).


Considering the low disease relapse rates and high rates of therapy-induced late side effects, as well as the increased risk of developing SC, a prospective multicentric trial investigating de-escalation of radiotherapy in this clearly defined low-risk patient population was started and is still recruiting patients (DIREKHT-Trial, NCT02528955).


Overall survival Disease-free survival Second cancer Late side effect Radio(chemo)therapy 

Gibt es Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region, die von einer Deintensivierung der postoperativen Bestrahlung profitieren könnten?

Eine monozentrische Analyse eines definierten Niedrigrisiko-Patientenkollektivs, das mit der Standardbestrahlung therapiert wurde



Ziel dieser retrospektiven Studie war es, das klinische Outcome für ein ausgewähltes Niedrigrisiko-Patientenkollektiv nach stattgehabter vollständiger Resektion (R0) von Plattenepithelkarzinomen der Mundhöhle, des Oropharynx, Larynx (pT1–3, pN0–pN2b), Hypopharynx (pT1–2, pN0–pN1) und der Indikation zur postoperativen Radio(chemo)therapie zu ermitteln.

Patienten und Methoden

Nach zuvor definierten Kriterien wurden 99 Patienten mit Plattenepithelkarzinomen im Kopf-Hals-Bereich, die sich vom 1. Januar 2005 bis 31. Dezember 2014 in unserer Klinik in Behandlung befanden, in die Auswertung einbezogen. Die Kaplan-Meier-Methode kam für die Berechnung der Überlebens- und Inzidenzrate zur Anwendung. Für die univariate Analyse wurde der Log-rank-Test zur Auswertung der prognostisch relevanten Parameter verwendet.


Das mediane Follow-up betrug 67 Monate. Das kumulative Gesamtüberleben (OS) und das kumulative krankheitsfreie Überleben (DFS) beliefen sich jeweils auf 97,9 %/94,7 %/88,0 % und 96,9 %/92,6 %/84,7 % nach 1, 2 und 5 Jahren. Die kumulativen Inzidenzen für das lokoregionäre Rezidiv (LRR), Fernmetastasen (DM) und das Zweitkarzinom (SC) betrugen jeweils 1,0 %/1,0 %/4,9 %, 0,0 %/3,4 %/5,8 % und 2,1 %/4,2 %/13,1 %. In der univariaten Analyse korrelierte die Primärtumorregion Oropharynx mit einem besseren OS (p = 0,043) und DFS (p = 0,048).


In Anbetracht der niedrigen Rezidivraten, der hohen Spätnebenwirkungsraten und des erhöhten SC-Risikos wurde eine prospektive, multizentrische Studie initiiert, die die Deeskalation der Strahlentherapie bei diesem ausgewählten Niedrigrisiko-Patientenkollektiv untersucht und noch Patienten rekrutiert (DIREKHT-Studie, NCT02528955).


Gesamtüberleben Krankheitsfreies Überleben Zweitkarzinom Spätnebenwirkung Radio(chemo)therapie 



The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. med. dent.”. I would give my sincere thanks to my helpful mentors Dr. Marlen Haderlein and Dr. Sebastian Lettmaier for their kind support.

Conflict of interest

Y. Onbasi, S. Lettmaier, M. Hecht, S. Semrau, H. Iro, M. Kesting, R. Fietkau, and M. Haderlein declare that they have no competing interests.


  1. 1.
    Wittekindt C, Wagner S, Mayer CS, Klussmann JP (2012) Basics of tumor development and importance of human papilloma virus (HPV) for head and neck cancer. GMS Curr Top Otorhinolaryngol Head Neck Surg. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Santarelli A, Lo Russo L, Bambini F, Campisi G, Lo Muzio L (2009) New perspectives in medical approach to therapy of head and neck squamous cell carcinoma. Minerva Stomatol 58:445–452PubMedGoogle Scholar
  3. 3.
    Perri F, Pacelli R, Della Vittoria Scarpati G et al (2015) Radioresistance in head and neck squamous cell carcinoma: biological bases and therapeutic implications. Head Neck 37:763–770CrossRefGoogle Scholar
  4. 4.
    Parkin DM, Bray F, Ferlay J, Pisani P (2001) Estimating the world cancer burden: Globocan 2000. Int J Cancer 94:153–156CrossRefGoogle Scholar
  5. 5.
    Maier H, Weidauer H (1995) Alcohol drinking and tobacco smoking are the chief risk factors for ENT tumors. Increased incidence of mouth cavity, pharyngeal and laryngeal carcinomas. Fortschr Med 113:157–160PubMedGoogle Scholar
  6. 6.
    Hashibe M, Brennan P, Chuang SC et al (2009) Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive. Oncology 18:541–550Google Scholar
  7. 7.
    IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2012) Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum 100:1–538PubMedCentralGoogle Scholar
  8. 8.
    Zhang ZF, Morgenstern H, Spitz MR et al (2000) Environmental tobacco smoking, mutagen sensitivity, and head and neck squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 9:1043–1049PubMedGoogle Scholar
  9. 9.
    Mehanna H, Beech T, Nicholson T et al (2013) Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer—systematic review and meta-analysis of trends by time and region. Head Neck 35:747–755CrossRefGoogle Scholar
  10. 10.
    Westra WH (2009) The changing face of head and neck cancer in the 21st century: the impact of HPV on the epidemiology and pathology of oral cancer. Head Neck Pathol 3:78–81CrossRefGoogle Scholar
  11. 11.
    Bernier J, Cooper JS, Pajak TF et al (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27:843–850CrossRefGoogle Scholar
  12. 12.
    Bernier J, Vermorken JB, Koch WM (2006) Adjuvant therapy in patients with resected poor-risk head and neck cancer. J Clin Oncol 24:2629–2635CrossRefGoogle Scholar
  13. 13.
    Denaro N, Russi EG, Adamo V, Colantonio I, Merlano MC (2011) Postoperative therapy in head and neck cancer: state of the art, risk subset, prognosis and unsolved questions. Oncology 81:21–29CrossRefGoogle Scholar
  14. 14.
    Cooper JS, Pajak TF, Forastiere AA et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944CrossRefGoogle Scholar
  15. 15.
    Bartelink H, Breur K, Hart G, Annyas B, van Slooten E, Snow G (1983) The value of postoperative radiotherapy as an adjuvant to radical neck dissection. Cancer 52:1008–1013CrossRefGoogle Scholar
  16. 16.
    Nisi KW, Foote RL, Bonner JA, McCaffrey TV (1998) Adjuvant radiotherapy for squamous cell carcinoma of the tongue base: improved local-regional disease control compared with surgery alone. Int J Radiat Oncol Biol Phys 41:371–377CrossRefGoogle Scholar
  17. 17.
    Bernier J, Domenge C, Ozsahin M et al (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefGoogle Scholar
  18. 18.
    Fietkau R, Lautenschläger C, Sauer R et al (2006) Postoperative concurrent radiochemotherapy versus radiotherapy in high-risk SCCA of the head and neck: Results of the German phase III trial ARO 96–3. J Clin Oncol 24:5507Google Scholar
  19. 19.
    Shelan M, Anschuetz L, Schubert AD et al (2017) T1–2 glottic cancer treated with radiotherapy and/or surgery. Strahlenther Onkol 193:995–1004CrossRefGoogle Scholar
  20. 20.
    Studer G, Bredell M, Studer S, Huber G, Glanzmann C (2016) Risk profile for osteoradionecrosis of the mandible in the IMRT era. Strahlenther Onkol 192:32–39CrossRefGoogle Scholar
  21. 21.
    Li XM, Di B, Shang YD, Tao ZF, Cheng JM, He ZG (2013) Value of postoperative radiation therapy for regional control after dissection in head and neck squamous cell carcinoma cases. Asian Pac J Cancer Prev 14:4273–4278CrossRefGoogle Scholar
  22. 22.
    Vermorken JB (2005) Medical treatment in head and neck cancer. Ann Oncol 16(Suppl 2):ii258–ii264CrossRefGoogle Scholar
  23. 23.
    Fritzsche K, Breitenstein K, Esser D (2010) Patients with malignancies of the oro- and hypopharynx as well as the larynx. Significance/importance of oncological aftercare consultation. HNO 58:756–761CrossRefGoogle Scholar
  24. 24.
    D’Souza G, Kreimer AR, Viscidi R et al (2007) Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 356:1944–1956CrossRefGoogle Scholar
  25. 25.
    Mirghani H, Amen F, Tao Y, Deutsch E, Levy A (2015) Increased radiosensitivity of HPV-positive head and neck cancers: molecular basis and therapeutic perspectives. Cancer Treat Rev 41:844–852CrossRefGoogle Scholar
  26. 26.
    Ang KK, Harris J, Wheeler R et al (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363:24–35CrossRefGoogle Scholar
  27. 27.
    Trosman SJ, Koyfman SA, Ward MC et al (2015) Effect of human papillomavirus on patterns of distant metastatic failure in oropharyngeal squamous cell carcinoma treated with chemoradiotherapy. JAMA Otolaryngol Head Neck Surg 141:457–462CrossRefGoogle Scholar
  28. 28.
    Mellin H, Friesland S, Lewensohn R, Dalianis T, Munck-Wikland E (2000) Human papillomavirus (HPV) DNA in tonsillar cancer: clinical correlates, risk of relapse, and survival. Int J Cancer 89:300–304CrossRefGoogle Scholar
  29. 29.
    Gillison ML, Koch WM, Capone RB et al (2000) Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst 92:709–720CrossRefGoogle Scholar
  30. 30.
    O’Rorke MA, Ellison MV, Murray LJ, Moran M, James J, Anderson LA (2012) Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis. Oral Oncol 48:1191–1201CrossRefGoogle Scholar
  31. 31.
    Ihloff AS, Knecht R, Tribius S (2010) HPV infection in head and neck squamous cell carcinoma (HNSCC). Highlights from ASCO 2010. HNO 58:1163–1167CrossRefGoogle Scholar
  32. 32.
    Nieder C (2016) Association of HPV infection, p16 status, and efficacy of radiotherapy with or without cetuximab in advanced oropharyngeal squamous cell carcinoma. Strahlenther Onkol 192:959–960CrossRefGoogle Scholar
  33. 33.
    Adelstein DJ, Ridge JA, Gillison ML et al (2009) Head and neck squamous cell cancer and the human papillomavirus: summary of a National Cancer Institute State of the Science Meeting, November 9–10, 2008, Washington, D.C. Head Neck 31:1393–1422CrossRefGoogle Scholar
  34. 34.
    Cardesa A, Nadal A (2011) Carcinoma of the head and neck in the HPV era. Acta Dermatovenerol Alp Pannonica Adriat 20:161–173PubMedGoogle Scholar
  35. 35.
    Chan JY (2013) Efficacy of neck dissection in the management of isolated nodal recurrence after head and neck cancer treatment. Curr Oncol Rep 15:142–145CrossRefGoogle Scholar
  36. 36.
    Sumi M, Sato S, Nakamura T (2017) Extranodal spread of primary and secondary metastatic nodes: the dominant risk factor of survival in patients with head and neck squamous cell carcinoma. PLoS ONE 12:e183611CrossRefGoogle Scholar
  37. 37.
    Ambrosch P, Kron M, Pradier O, Steiner W (2001) Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Head Neck Surg 124:180–187CrossRefGoogle Scholar
  38. 38.
    Wang X, Mauer EA, Christos P, Manzerova J, Wernicke AG, Parashar B (2017) First clinical report on comparative treatment and survival outcomes in second cancers after primary head and neck cancer: a population-based study. Cureus 9:e1284PubMedPubMedCentralGoogle Scholar
  39. 39.
    Leon X, Del Prado Venegas M, Orus C, Kolanczak K, Garcia J, Quer M (2005) Metachronous second primary tumours in the aerodigestive tract in patients with early stage head and neck squamous cell carcinomas. Eur Arch Otorhinolaryngol 262:905–909CrossRefGoogle Scholar
  40. 40.
    Baxi SS, Pinheiro LC, Patil SM, Pfister DG, Oeffinger KC, Elkin EB (2014) Causes of death in long-term survivors of head and neck cancer. Cancer 120:1507–1513CrossRefGoogle Scholar
  41. 41.
    Li Z, Seah TE, Tang P, Ilankovan V (2011) Incidence of second primary tumours in patients with squamous cell carcinoma of the tongue. Br J Oral Maxillofac Surg 49:50–52CrossRefGoogle Scholar
  42. 42.
    Argiris A, Brockstein BE, Haraf DJ et al (2004) Competing causes of death and second primary tumors in patients with locoregionally advanced head and neck cancer treated with chemoradiotherapy. Clin Cancer Res 10:1956–1962CrossRefGoogle Scholar
  43. 43.
    Rosenthal DI, Mohamed ASR, Garden AS et al (2017) Final report of a prospective randomized trial to evaluate the dose-response relationship for postoperative radiation therapy and pathologic risk groups in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 98:1002–1011CrossRefGoogle Scholar
  44. 44.
    Morris LG, Sikora AG, Patel SG, Hayes RB, Ganly I (2011) Second primary cancers after an index head and neck cancer: subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer. J Clin Oncol 29:739–746CrossRefGoogle Scholar
  45. 45.
    Khuri FR, Kim ES, Lee JJ et al (2001) The impact of smoking status, disease stage, and index tumor site on second primary tumor incidence and tumor recurrence in the head and neck retinoid chemoprevention trial. Cancer Epidemiol Biomarkers Prev 10:823–829PubMedGoogle Scholar
  46. 46.
    Chen MC, Huang WC, Chan CH, Chen PT, Lee KD (2010) Impact of second primary esophageal or lung cancer on survival of patients with head and neck cancer. Oral Oncol 46:249–254CrossRefGoogle Scholar
  47. 47.
    Leon X, del Prado Venegas M, Orus C, Lopez M, Garcia J, Quer M (2009) Influence of the persistence of tobacco and alcohol use in the appearance of second neoplasm in patients with a head and neck cancer. A case-control study. Cancer Causes Control 20:645–652CrossRefGoogle Scholar
  48. 48.
    Peck BW, Dahlstrom KR, Gan SJ et al (2013) Low risk of second primary malignancies among never smokers with human papillomavirus-associated index oropharyngeal cancers. Head Neck 35:794–799CrossRefGoogle Scholar
  49. 49.
    Xu CC, Biron VL, Puttagunta L, Seikaly H (2013) HPV status and second primary tumours in oropharyngeal squamous cell carcinoma. J Otolaryngol Head Neck Surg 42:36CrossRefGoogle Scholar
  50. 50.
    McGovern SL, Williams MD, Weber RS et al (2010) Three synchronous HPV-associated squamous cell carcinomas of Waldeyer’s ring: case report and comparison with Slaughter’s model of field cancerization. Head Neck 32:1118–1124CrossRefGoogle Scholar
  51. 51.
    Huang SF, Li HF, Liao CT et al (2012) Association of HPV infections with second primary tumors in early-staged oral cavity cancer. Oral Dis 18:809–815CrossRefGoogle Scholar
  52. 52.
    Ringash J, Bernstein LJ, Cella D et al (2015) Outcomes toolbox for head and neck cancer research. Head Neck 37:425–439CrossRefGoogle Scholar
  53. 53.
    Alshadwi A, Nadershah M, Carlson ER, Young LS, Burke PA, Daley BJ (2013) Nutritional considerations for head and neck cancer patients: a review of the literature. J Oral Maxillofac Surg 71:1853–1860CrossRefGoogle Scholar
  54. 54.
    Murphy BA (2007) A critical component of supportive care. J Support Oncol 5:228–229PubMedGoogle Scholar
  55. 55.
    Brosky ME (2007) The role of saliva in oral health: strategies for prevention and management of xerostomia. J Support Oncol 5:215–225PubMedGoogle Scholar
  56. 56.
    Badwal RS, Bennett J (2003) Nutritional considerations in the surgical patient. Dent Clin North Am 47:373–393CrossRefGoogle Scholar
  57. 57.
    Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 41:283–288CrossRefGoogle Scholar
  58. 58.
    Alterio D, Gerardi MA, Cella L et al (2017) Radiation-induced acute dysphagia: prospective observational study on 42 head and neck cancer patients. Strahlenther Onkol 193:971–981CrossRefGoogle Scholar
  59. 59.
    Ursino S, D’Angelo E, Mazzola R et al (2017) A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy : a systematic review by the Italian Head and Neck Radiotherapy Study Group. Strahlenther Onkol 193:877–889CrossRefGoogle Scholar
  60. 60.
    Infante-Cossio P, Torres-Carranza E, Cayuela A, Hens-Aumente E, Pastor-Gaitan P, Gutierrez-Perez JL (2009) Impact of treatment on quality of life for oral and oropharyngeal carcinoma. Int J Oral Maxillofac Surg 38:1052–1058CrossRefGoogle Scholar
  61. 61.
    Mehanna HM, Morton RP (2006) Deterioration in quality-of-life of late (10-year) survivors of head and neck cancer. Clin Otolaryngol 31:204–211CrossRefGoogle Scholar
  62. 62.
    Oskam IM, Verdonck-de Leeuw IM, Aaronson NK et al (2013) Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol 49:443–448CrossRefGoogle Scholar
  63. 63.
    Jensen K, Overgaard M, Grau C (2007) Morbidity after ipsilateral radiotherapy for oropharyngeal cancer. Radiother Oncol 85:90–97CrossRefGoogle Scholar
  64. 64.
    Cerezo L, Martin M, Lopez M, Marin A, Gomez A (2009) Ipsilateral irradiation for well lateralized carcinomas of the oral cavity and oropharynx: results on tumor control and xerostomia. Radiat Oncol 4:33CrossRefGoogle Scholar
  65. 65.
    Vergeer MR, Doornaert PA, Jonkman A et al (2010) Ipsilateral irradiation for oral and oropharyngeal carcinoma treated with primary surgery and postoperative radiotherapy. Int J Radiat Oncol Biol Phys 78:682–688CrossRefGoogle Scholar
  66. 66.
    Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA (2001) Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 50:695–704CrossRefGoogle Scholar
  67. 67.
    Mortensen HR, Jensen K, Aksglaede K, Behrens M, Grau C (2013) Late dysphagia after IMRT for head and neck cancer and correlation with dose-volume parameters. Radiother Oncol 107:288–294CrossRefGoogle Scholar
  68. 68.
    Vlacich G, Spratt DE, Diaz R et al (2014) Dose to the inferior pharyngeal constrictor predicts prolonged gastrostomy tube dependence with concurrent intensity-modulated radiation therapy and chemotherapy for locally-advanced head and neck cancer. Radiother Oncol 110:435–440CrossRefGoogle Scholar
  69. 69.
    Vainshtein JM, Griffith KA, Feng FY, Vineberg KA, Chepeha DB, Eisbruch A (2014) Patient-reported voice and speech outcomes after whole-neck intensity modulated radiation therapy and chemotherapy for oropharyngeal cancer: prospective longitudinal study. Int J Radiat Oncol Biol Phys 89:973–980CrossRefGoogle Scholar
  70. 70.
    Eisbruch A, Schwartz M, Rasch C et al (2004) Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 60:1425–1439CrossRefGoogle Scholar
  71. 71.
    Bernier J (2006) Head and neck oncology: what the past decade has taught us. Expert Rev Anticancer Ther 6:1133–1136CrossRefGoogle Scholar
  72. 72.
    Osazuwa-Peters N, Massa ST, Simpson MC, Adjei Boakye E, Varvares MA (2018) Survival of human papillomavirus-associated cancers: filling in the gaps. Cancer 124:18–20CrossRefGoogle Scholar
  73. 73.
    Forastiere A, Koch W, Trotti A, Sidransky D (2001) Head and neck cancer. N Engl J Med 345:1890–1900CrossRefGoogle Scholar
  74. 74.
    Peters LJ, Goepfert H, Ang KK et al (1993) Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys 26:3–11CrossRefGoogle Scholar
  75. 75.
    Kim Y, Cho KH, Moon SH et al (2017) Comparison of the clinical outcomes of patients with squamous cell carcinoma of the tonsil receiving postoperative ipsilateral versus bilateral neck radiotherapy: a propensity score matching analysis (KROG 11-07). Cancer Res Treat 49:1097–1105CrossRefGoogle Scholar
  76. 76.
    Al-Mamgani A, van Rooij P, Fransen D, Levendag P (2013) Unilateral neck irradiation for well-lateralized oropharyngeal cancer. Radiother Oncol 106:69–73CrossRefGoogle Scholar
  77. 77.
    Lynch J, Lal P, Schick U et al (2014) Multiple cervical lymph node involvement and extra-capsular extension predict for contralateral nodal recurrence after ipsilateral radiotherapy for squamous cell carcinoma of the tonsil. Oral Oncol 50:901–906CrossRefGoogle Scholar
  78. 78.
    Huang SH, Waldron J, Bratman SV et al (2017) Re-evaluation of ipsilateral radiation for T1–T2N0–N2b tonsil carcinoma at the princess margaret hospital in the human papillomavirus era, 25 years later. Int J Radiat Oncol Biol Phys 98:159–169CrossRefGoogle Scholar
  79. 79.
    Jellema AP, Slotman BJ, Doornaert P, Leemans CR, Langendijk JA (2007) Unilateral versus bilateral irradiation in squamous cell head and neck cancer in relation to patient-rated xerostomia and sticky saliva. Radiother Oncol 85:83–89CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany
  2. 2.Department of ProsthodonticsUniversity Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany
  3. 3.Department of OtorhinolaryngologyUniversity Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany
  4. 4.Department of Oral and Maxillofacial SurgeryUniversity Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany

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