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Neck management in head and neck squamous cell carcinomas: where do we stand? Med Oncol 2019; 36:40. [DOI: 10.1007/s12032-019-1265-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/19/2019] [Indexed: 01/06/2023]
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Nevens D, Duprez F, Bonte K, Deron P, Huvenne W, Laenen A, De Neve W, Nuyts S. Upfront vs. no upfront neck dissection in primary head and neck cancer radio(chemo)therapy: Tumor control and late toxicity. Radiother Oncol 2017; 124:220-224. [DOI: 10.1016/j.radonc.2017.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Up-front neck dissection followed by definitive (chemo)-radiotherapy in head and neck squamous cell carcinoma: Rationale, complications, toxicity rates, and oncological outcomes – A systematic review. Radiother Oncol 2016; 119:185-93. [DOI: 10.1016/j.radonc.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/05/2016] [Accepted: 03/02/2016] [Indexed: 12/25/2022]
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Elicin O, Albrecht T, Haynes AG, Bojaxhiu B, Nisa L, Caversaccio M, Dal Pra A, Schmücking M, Aebersold DM, Giger R. Outcomes in Advanced Head and Neck Cancer Treated with Up-front Neck Dissection prior to (Chemo)Radiotherapy. Otolaryngol Head Neck Surg 2015; 154:300-8. [PMID: 26450749 DOI: 10.1177/0194599815608370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our aim was to compare outcomes with and without up-front neck dissection prior to (chemo)radiotherapy in head and neck squamous cell carcinoma. STUDY DESIGN Case series with chart review. SETTING Tertiary referral center. SUBJECTS AND METHODS Outcomes of oropharyngeal, laryngeal, and hypopharyngeal squamous cell carcinoma cases with neck lymph node metastases treated from January 2001 to March 2012 were analyzed. Due to imbalances in baseline characteristics between groups treated with (n = 129) and without (n = 95) up-front neck dissection, propensity score matching was performed. RESULTS Median follow-up was 48 months (range, 12-148). With up-front neck dissection, the hazard ratio for the primary end point, disease-free survival, was 0.63 (95% confidence interval: 0.37-1.06, P = .08). Up-front neck dissection reduced acute grade ≥3 toxicity significantly when xerostomia was excluded (odds ratio: 0.40, 95% confidence interval: 0.20-0.82, P = .012). CONCLUSION Our results indicate less acute treatment toxicity without any significant difference in terms of oncologic outcome with up-front neck dissection prior to (chemo)radiotherapy as compared with (chemo)radiotherapy alone. Well-designed randomized trials are required to verify this result and further investigate the impact of this strategy on late toxicity and oncologic outcome.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Tobias Albrecht
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Alan G Haynes
- Clinical Trials Unit Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lluís Nisa
- Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michael Schmücking
- Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Shenoy AM, Shiva Kumar T, Prashanth V, Chavan P, Halkud R, Jacob L, Govind Babu K, Lokesh G, Pasha T, Kumar RV. Neck dissection followed by definitive radiotherapy for small upper aerodigestive tract squamous cell carcinoma, with advanced neck disease: an alternative treatment strategy. Indian J Otolaryngol Head Neck Surg 2012; 65:48-52. [PMID: 24427615 DOI: 10.1007/s12070-011-0469-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 12/26/2011] [Indexed: 11/27/2022] Open
Abstract
Treatment options for patients with small upper aerodigestive tracts squamous cell carcinoma (T1, T2) with advanced neck disease (N2, N3) is a topic that generates controversy in terms of thereuptic stratagies. We present the retrospective analysis of 109 patients treated, between 1991 and 2008, by "Neck dissection first approach" for N2, N3 neck node, followed by external beam radiotherapy (RT) with or without chemotherapy for the operated neck and the primary, deemed radiocurable. 94 patients completed the planned treatment and formed the material for this study. The primary (tumor) stage was as follows: T1 (29) and T2 (65) commonly arising from oropharynx; the neck nodes were predominantly N2a (n = 54), followed by N2b (n = 26) and N3 (n = 14) disease. Complete nodal clearence was achieved in 89 patients, with no major post operative complications. With a median follow up of 24 months disease free survival of 70% and overall survival of 61% at 5 years. Recurrence at primary site was noted predominantly with pyriform fossa tumors (n = 8), followed by base of tongue (n = 5) and were T2 lesions. Failure in the neck was seen in predominantly N3 nodes, R1 resection and failure to comply with adjuvant treatment. Neck dissection first approach is a valid treatment option that allows a good control of the disease in the neck, where it often fails if only RT is administered, along with preserving the pharyngolaryngeal function. Care should be excercised so that there should be no delay in initiating the RT following surgery.
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Affiliation(s)
- Ashok M Shenoy
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India
| | - T Shiva Kumar
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India
| | - V Prashanth
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India
| | - Purushotham Chavan
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India
| | - Rajshekar Halkud
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Dr.M.H.Marigowda Road, 560029 Bangalore, Karnataka India
| | - Linu Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
| | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
| | - G Lokesh
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
| | - Tanveer Pasha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
| | - Rekha V Kumar
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
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D'cruz AK, Pantvaidya GH, Agarwal JP, Chaukar DA, Pathak KA, Deshpande MS, Pai PS, Chaturvedi P, Dinshaw KA. Split therapy: Planned neck dissection followed by definitive radiotherapy for a T1, T2 pharyngolaryngeal primary cancer with operable N2, N3 nodal metastases—A prospective study. J Surg Oncol 2005; 93:56-61. [PMID: 16353188 DOI: 10.1002/jso.20399] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The management of patients with a small pharyngolaryngeal cancer (T1 and T2) with large nodal metastases is a subject of debate. We present data on the feasibility and outcome of treating these patients with surgery for the nodal metastases followed by definitive radiotherapy. METHODS Prospective study of 59 patients of small pharyngolaryngeal primary squamous carcinomas with operable (N2/N3) nodal metastasis treated with neck dissection followed by radiotherapy. RESULTS Complete nodal clearance was achieved in 54 (90%). The mean nodal size was 4 cm and extranodal extension was seen in 88% of patients in the study group. There were no significant postoperative complications. Median interval between surgery and radiotherapy was 23 days. Forty-nine patients (83%) started their RT within 6 weeks of surgery. With a median follow-up of 25 months, the disease free and overall survival was 54% and 60% (5 years). CONCLUSION The management of patients with a radiocurable pharyngolaryngeal primary with large nodes by this approach is a feasible option with adequate control and survival.
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Affiliation(s)
- A K D'cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
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Allal AS, Dulguerov P, Bieri S, Lehmann W, Kurtz JM. A conservation approach to pharyngeal carcinoma with advanced neck disease: optimizing neck management. Head Neck 1999; 21:217-22. [PMID: 10208664 DOI: 10.1002/(sici)1097-0347(199905)21:3<217::aid-hed6>3.0.co;2-s] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Surgical management of advanced neck disease remains controversial when a conservative approach based on radiotherapy is retained for primary tumors. The objective of this study was to evaluate retrospectively treatment results in pharyngeal cancers presenting with N2-N3 neck disease, using neck dissection followed by radical locoregional radiotherapy (RT) and to compare these results with those obtained in patients treated by radical RT alone. METHODS From August 1991 to November 1996, 41 patients with carcinomas of the oro- or hypopharynx were staged as T1-T3 N2-N3 M0 (American Joint Committee on Cancer [AJCC] stage IV). Twenty-four patients were treated with neck dissection followed by RT (group 1) and 17 patients with radical RT (group 2) using a progressively accelerated concomitant boost schedule. Chemotherapy was delivered to 6 patients in group 1 and 8 in group 2 partially concomitantly with RT. RESULTS Three-year actuarial locoregional control was 73% and 55% for groups 1 and 2, respectively (p = .52). The corresponding 3-year actuarial overall survival rates were 37% and 50% (p = .42). Severe postoperative complications were observed after neck dissection in four patients (16%). Acute toxicity during RT was similar in the two groups. Late toxicities were also similar, except for two patients in group 1 who developed severe laryngeal edema. CONCLUSIONS Neck dissection followed by radical RT to the primary tumor and neck represents a valid treatment option in this subset of patients, allowing good control of advanced neck disease, while at the same time conserving pharyngolaryngeal function. However, for patients who are at high risk of severe postoperative complications, radical RT can be considered a worthy alternative, particularly for oropharyngeal carcinomas.
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Affiliation(s)
- A S Allal
- Division of Radiation Oncology, University Hospital of Geneva, Switzerland
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Verschuur HP, Keus RB, Hilgers FJ, Balm AJ, Gregor RT. Preservation of function by radiotherapy of small primary carcinomas preceded by neck dissection for extensive nodal metastases of the head and neck. Head Neck 1996; 18:277-82. [PMID: 8860770 DOI: 10.1002/(sici)1097-0347(199605/06)18:3<277::aid-hed10>3.0.co;2-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease. METHOD A retrospective review was conducted over an 8-year period; of the 619 patients seen during this time, 15 were judged suitable for this approach. Small primaries were defined as T1 or T2 lesions or superficial spreading T3 tumors. Extensive neck disease was defined as at least 3 cm in size. RESULTS There were no regional recurrences and only 3 local recurrences, 2 of which were successfully salvaged. Four patients died of distant metastases. The arguments for and against this unusual approach are discussed. CONCLUSIONS It is concluded that, in patients conforming to our criteria, this is a sound oncologic approach.
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Affiliation(s)
- H P Verschuur
- Department of Otolaryngology, The Netherlands Cancer Institute, Amsterdam
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Houck JR, Medina JE. Management of cervical lymph nodes in squamous carcinomas of the head and neck. SEMINARS IN SURGICAL ONCOLOGY 1995; 11:228-39. [PMID: 7638510 DOI: 10.1002/ssu.2980110308] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Due to the overwhelming prognostic significance of regional metastases, proper management of cervical lymph nodes in cases of squamous cell carcinoma of the head and neck is essential for an optimal outcome. Better understanding of the predictability of incidence and patterns of metastases of these tumors in recent years has led us away from the radical neck dissection as the only surgical therapeutic or staging procedure done on the neck. Recent studies suggest that selective removal of lymph node groups at risk in clinically negative necks, or modified neck dissections that save important structures, like the jugular vein, XI nerve, and sternocleidomastoid muscle, in clinically positive necks, are appropriate in many patients. Careful selection of the type of neck dissection and judicious use of postoperative radiation therapy can optimize cure rates as well as functional and cosmetic results.
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Affiliation(s)
- J R Houck
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City 73190-3048, USA
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