Are We Over-treating Neck in Buccal & Alveolo-buccal Cancers: Experience from a Tertiary Cancer Care Center

Abstract

Oral cancer is one of the most common types of cancer seen in India with buccal and alveolo buccal regions being the most frequent subsites. A retrospective analysis of buccal and alveolo buccal cancer patients undergoing neck dissection from 1995 to 2009 was performed to analyze the profile of neck dissections and patterns of nodal involvement in these patients. Total 310 neck dissections were done for buccal and alveolo-buccal cancer including 41 (13.2 %) RND, 231(74.5 %) MND and 38 (12.2 %) Supraomohyoid neck dissection (SOHND). Clinically palpable nodes were present in 75.9 % patients but only 117 (38 %) were pathologically node positive. 20 % had occult positive nodes in N0 group. Level I was most commonly involved with 35 % having positive nodes in more than one level. There were no patients with isolated involvement of level IV or V with only 3.9 % patients with involvement of level III. Current guidelines recommend neck dissection in all clinically node positive patients. However, our experience shows that neck is over treated in majority of patients and there is a need to optimize surgical management of neck in these patients.

An Epidemiological Model to Find out Factors Associated with Nodal Involvement among Indian Oral Cancer Patients

“…[23] and which was also focused by Dr. Deo (2012) on the data from the same centre[12]. In the present study, nodal involvement was found in 39.8% of the cases.…”

“…Hence, along with treating the primary lesion, appropriate management of the cervical lymph nodes is an important part of oral cancer therapy [12] [19] [20] [21]. Also, there has long been controversy over the indication, timing and methods of neck dissection [20] [21].…”

“…Also, there has long been controversy over the indication, timing and methods of neck dissection [20] [21]. Latest in 2102, Dr. Deo also shows his concern regarding treatment of neck, on the data from same centre in Buccal and Alvelo-buccal cancer [12]. Difficulty in early diagnosis thus restricts the treatment carried out by surgeons [13].…”

“…Difficulty in early diagnosis thus restricts the treatment carried out by surgeons [13]. A reliable and accurate means of preoperative evaluation of cervical lymph node metastasis is therefore crucial for the correct management of oral cancer [12] [18] [21] [22] [23]. Hence, establishment of an adequate therapeutic regimen is required through elucidation of possible factors involved in metastasis in the cervical lymph nodes in individual cases.…”

Ordinal logistic regression model describing factors associated with extent of nodal involvement in oral cancer patients and its prospective validation

“…In other words, the outcome of oral cancer may significantly change due to the nodal involvement. Hence, appropriate management of the cervical lymph nodes is an important part of oral cancer therapy [8][9][10][11][12][13]. However, there has been controversy over the indication, timing and methods of neck dissection [12,13].…”