Elective neck dissection for the management of the N0 neck in early cancer of the oral tongue: Need for a randomized controlled trial

D’Cruz, Anil; Siddachari, Ravichand; Walvekar, Rohan R.; Pantvaidya, Gouri; Chaukar, Devendra; Deshpande, Mandar; Pai, Prathamesh; Chaturvedi, Pankaj

doi:10.1002/hed.20988

Cited by 125 publications

(97 citation statements)

References 33 publications

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“…Since the presence of occult metastases is an additional risk factor, which might reduce patients overall and disease-free survival time, several authors argue, that all patients with OSCC and clinically N0 neck should receive elective neck dissection (Capote et al, 2007;Cheng and Schmidt, 2008). The results of other studies, however, suggest that a "watchful-waiting" strategy with regular examination intervals and salvage treatment in case of loco-regional recurrence might be sufficient to achieve similar overall and disease-free survival rates in OSCC patients with early tumours and a clinically N0 neck (D'Cruz et al, 2009). Our retrospective analysis, however, demonstrated that the presence of occult metastases is associated with a reduction of the overall and disease-free survival time of the patients.…”

Section: Discussionmentioning

confidence: 92%

The role of elective supraomohyoidal neck dissection in the treatment of early, node-negative oral squamous cell carcinoma (OSCC): A retrospective analysis of 122 cases

Thiele

Seeberger

Flechtenmacher

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 92%

The role of elective supraomohyoidal neck dissection in the treatment of early, node-negative oral squamous cell carcinoma (OSCC): A retrospective analysis of 122 cases

Thiele

Seeberger

Flechtenmacher

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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“…The incidence of nodal metastasis is higher for early cancer of the tongue when compared with other sites of the oral cavity. AK D'cruz et al found the incidence of nodal metastasis to be 37.5% in T1 lesions and 62.5% in T2 lesions of the oral tongue [9]. Andersen et al studied the results of neck failure following observation of N0 necks.…”

Section: Discussionmentioning

confidence: 99%

To Operate or Not to Operate N0 Neck in Early Cancer of the Tongue? A Prospective Study

Vijayakumar

Burrah

Sabitha

et al. 2011

Indian J Surg Oncol

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Squamous cell carcinoma (SCC) of the tongue is a common cancer across the globe. These cancers have a high predilection for nodal metastasis and a high incidence of occult metastasis. The management of clinically negative neck nodes (N0) remains controversial. We have undertaken a prospective study to evaluate the rate of occult nodal metastasis, the characteristic of metastasis, and assess the usefulness of tumor depth as a predictor of metastasis and as a guide to treat the neck. Prospective study between January 2000 to December 2005. Patients with SCC of the anterior 2/3rd of tongue with N0 neck were included. Wide excision of the primary and subsequent modified radical neck dissection (in patients with tumor depth>4 mm) was performed. Postoperative radiotherapy was given in patients with lymph node metastasis. Patients who had no node metastasis (p N -ve) were observed. The total number of eligible patients was 180. Occult lymph node metastasis (p N +ve) was seen in 122 (62.2%) patients (p<0.001), multiple levels of node involvement in 79 (70.5%) patients and extracapsular spread (ECS) in 38 (33.6%) patients. Patients in the p N +ve group who were disease free was 63.1% as compared to 68.2% in the p N -ve group (p=0.36). Recurrence was seen in 28 (36.8%) patients of p N +ve group and 14 (31.8%) patients of p N -ve group. Early cancer of tongue with tumor depth >4 mm was associated with predominantly high grade tumors, high incidence of occult nodal metastasis, multiple levels of nodal involvement and ECS. The disease free status of patients with occult metastasis who were treated was similar to that of patients with no nodal metastasis. Elective neck dissection appears essential for early oral tongue cancer with tumor depth >4 mm as there is no investigational modality which can reliably identify patients without occult metastasis.

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“…Many histo-pathologic features have been previously investigated as risk factors for occult cervical lymph node metastasis in early OTC but there is no consensus [9,10,18] and there is still controversy regarding the management of clinical N0 neck [19]. The PVI and PLI are identified as the factors of RR but no statistical difference in DFS or OS between elective treatment and observation groups in the present study.…”

Section: Discussionmentioning

confidence: 49%

Impact of Clinical and Histo-Pathological Prognostic Factors on T1-2N0-1 Oral Tongue Carcinoma

Sittitrai

Srivanitchapoom

Mahanupab

et al. 2012

Indian J Otolaryngol Head Neck Surg

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To determine predictive factors which affect local and regional recurrence of T1-2N0-1M0 oral tongue carcinoma (OTC). Records of 42 patients with T1-2N0-1 M0 OTC were reviewed. The clinical characteristics, histopathological data, disease recurrence and survival rate were analyzed. Descriptive statistics and Kaplan-Meier survival analysis were used. The median follow up was 38 months. The 2-year overall survival and disease-free survival rates were 85.7 and 55.6 % respectively. At the 2 year analysis, there were surgical margin\5 mm (p value = 0.01), tumor thickness [7 mm (p value = 0.03), perivascular and perilymphatic invasion (p value = 0.01) affected on local recurrence and perivascular and perilymphatic invasion were also predictors for regional recurrence (p value = 0.04). The surgical margin status, tumor thickness, perivascular and perilymphatic invasion represented significant predictive factors for local recurrent OTC. Postoperative adjuvant therapy should be considered in these groups.

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Elective neck dissection for the management of the N0 neck in early cancer of the oral tongue: Need for a randomized controlled trial

Abstract: END did not impact disease-free or OS. Current literature still remains divided on this issue emphasizing the need for a randomized controlled trial.

Cited by 125 publications

References 33 publications

The role of elective supraomohyoidal neck dissection in the treatment of early, node-negative oral squamous cell carcinoma (OSCC): A retrospective analysis of 122 cases

The role of elective supraomohyoidal neck dissection in the treatment of early, node-negative oral squamous cell carcinoma (OSCC): A retrospective analysis of 122 cases

To Operate or Not to Operate N0 Neck in Early Cancer of the Tongue? A Prospective Study

Impact of Clinical and Histo-Pathological Prognostic Factors on T1-2N0-1 Oral Tongue Carcinoma

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