Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer

Brizel, D.M.

doi:10.1016/s0360-3016(03)01927-8

Cited by 88 publications

(170 citation statements)

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“…In comparison, a strategy based on combined PET/CT findings could have reduced the number of such procedures to 13 (5 TP, 8 FP) while missing 2 of the 84 heminecks (2%) or 2 of 7 heminecks eventually found to harbor residual disease. Although clinical factors, such as the initial nodal stage, are also important considerations, none of these parameters can reliably identify the subset of patients requiring surgical intervention after the end of chemoradiotherapy (5,(10)(11)(12)(13)34). Thus, a PET/CT-based strategy might reduce the element of arbitrary decision making in these patients, but this would have to be confirmed in a prospective study.…”

Section: Discussionmentioning

confidence: 99%

“…Whether planned neck dissection, which is aimed at an improvement in locoregional control, also leads to improved disease-free and overall survival remains controversial (5,34). In one study (34), the 4-y disease-free survival in patients with N2-N3 disease and complete clinical response, which was followed by planned neck dissection, was 75% as compared with 53% in patients with complete clinical response but no neck dissection.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Ong

Schöder²,

Lee³

et al. 2008

J Nucl Med

252

188

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Ong

Schöder²,

Lee³

et al. 2008

J Nucl Med

252

188

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“…2 Brizel et al demonstrated a decreased rate of neck control by 35% in patients with N2 or greater regional disease who received CRT without ND as compared to ND patients. 3 When occult metastases are present, overall survival drops to levels found in patients who present with node-positive necks at diagnosis, irrespective of the primary treatment modality employed. 4 Failure in the neck after definitive neck treatment offers a distinctively poorer prognosis than local recurrences.…”

Section: Neck Nodes Are Important Prognostic Factor Affecting Survivalmentioning

confidence: 99%

Salvage Neck Dissection after Chemoradiation in Head and Neck Cancer: Practice and Pitfalls

Agarwal¹,

Kundu²,

Krishnatry³

et al. 2012

International Journal of Head and Neck Surgery

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Locally advanced head and neck cancers are usually treated with concurrent chemoradiation. The residual nodes after chemoradiation in such patients are a common scenario, but the further investigation and treatment options in form of neck dissection are still not very clear. This review focuses on the current state of available evidence in literature for management of such patients and directs for the future development to fill the lacunae.

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“…1,2 Retrospective studies showed persistent disease on histopathological examination of nodes in up to 40% of patients who underwent neck dissection after chemoradiotherapy 3 and some evidence of a significant survival advantage associated with planned neck dissection. 4,5 However, owing to improvements in cross-sectional imaging, consistently low rates of recurrence (<10%) have been reported among the 30 to 45% of patients who have been found to have a complete response on imaging after chemoradiotherapy. 6,7 Thus, the adoption of image-guided, response-based approaches has increased, albeit without level I evidence.…”

mentioning

confidence: 99%

PET-CT surveillance versus neck dissection in advanced head and neck cancer

2016

Br Dent J

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BACKGROUNDThe role of image-guided surveillance as compared with planned neck dissection in the treatment of patients with squamous-cell carcinoma of the head and neck who have advanced nodal disease (stage N2 or N3) and who have received chemoradiotherapy for primary treatment is a matter of debate. METHODSIn this prospective, randomized, controlled trial, we assessed the noninferiority of positron-emission tomography-computed tomography (PET-CT)-guided surveillance (performed 12 weeks after the end of chemoradiotherapy, with neck dissection performed only if PET-CT showed an incomplete or equivocal response) to planned neck dissection in patients with stage N2 or N3 disease. The primary end point was overall survival. RESULTSFrom 2007 through 2012, we recruited 564 patients (282 patients in the planned-surgery group and 282 patients in the surveillance group) from 37 centers in the United Kingdom. Among these patients, 17% had nodal stage N2a disease and 61% had stage N2b disease. A total of 84% of the patients had oropharyngeal cancer, and 75% had tumor specimens that stained positive for the p16 protein, an indicator that human papillomavirus had a role in the causation of the cancer. The median follow-up was 36 months. PET-CT-guided surveillance resulted in fewer neck dissections than did planned dissection surgery (54 vs. 221); rates of surgical complications were similar in the two groups (42% and 38%, respectively). The 2-year overall survival rate was 84.9% (95% confidence interval [CI], 80.7 to 89.1) in the surveillance group and 81.5% (95% CI, 76.9 to 86.3) in the planned-surgery group. The hazard ratio for death slightly favored PET-CT-guided surveillance and indicated noninferiority (upper boundary of the 95% CI for the hazard ratio, <1.50; P = 0.004). There was no significant difference between the groups with respect to p16 expression. Quality of life was similar in the two groups. PET-CT-guided surveillance, as compared with neck dissection, resulted in savings of £1,492 (approximately $2,190 in U.S. dollars) per person over the duration of the trial. CONCLUSIONSSurvival was similar among patients who underwent PET-CT-guided surveillance and those who underwent planned neck dissection, but surveillance resulted in considerably fewer operations and it was more cost-effective.

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Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer

Cited by 88 publications

References 0 publications

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Salvage Neck Dissection after Chemoradiation in Head and Neck Cancer: Practice and Pitfalls

PET-CT surveillance versus neck dissection in advanced head and neck cancer

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Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer

Cited by 88 publications

References 0 publications

Clinical Utility of18F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Clinical Utility of18F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Salvage Neck Dissection after Chemoradiation in Head and Neck Cancer: Practice and Pitfalls

PET-CT surveillance versus neck dissection in advanced head and neck cancer

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Product

Resources

About

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer