Avoidance of postoperative irradiation for cervical lymph node metastases of human papillomavirus‐related tonsillar cancer

BACKGROUND: Several reports have suggested that selected patients with human papillomavirus‐related oropharyngeal cancer can be managed with surgery alone. We retrospectively reviewed tonsillar cancer cases to analyze treatment de‐intensification after transoral resection. METHODS: Eighteen patients with tonsillar cancer who had undergone transoral resection were included. The patients' characteristics, p16 status, adverse features, clinical course, overall survival, and relapse‐free survival according to p16 status were retrospectively examined. RESULTS: Four lesions showed positive surgical margins and one lesion showed close surgical margin; these patients were treated with postoperative irradiation. Seven p16‐positive patients had multiple node metastases and two had extracapsular spread. No p16‐positive patients agreed to postoperative irradiation, and recurrence within the surgical field was not observed. The five‐year overall and relapse‐free survival rates were 89% and 74%, respectively. The five‐year relapse‐free survival rates of p16‐positive and p16‐negative patients were 81% and 50%, respectively (p = .075). CONCLUSIONS: Postoperative irradiation for cervical lymph node metastases might be avoidable in selected patients with human papillomavirus‐related tonsillar cancer. LEVEL OF EVIDENCE: 4.