Neck metastases in oropharyngeal cancer: Necessity and extent of bilateral treatment

Abstract

Bilateral neck disease in OPSCC is more common than once thought. Patients with OPSCC with cT4 or cN2a+ would benefit from bilateral neck treatment. Posttreatment high-risk features should guide treatment escalation.

Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review

“…In the study by Buckley et al, only those cases with an N stage of N1, N2a, and N2b were included . From Dziegielewski et al, only those cases with an N stage of N1 or N2a could be used …”

“…The survival data for most studies were excluded from this review because survival outcomes were often pooled with irrelevant data. Da Mosto et al and Dziegielewski et al reported a 5‐year disease‐free survival (DFS) of 58.3% and 87%, respectively, but these figures included some patients with initially clinically staged N0 neck disease . For both studies, regional recurrence for the clinically N‐positive neck with level V uninvolved was still able to be determined.…”

“…Above this threshold, the oncologic benefits of surgery outweighed operative morbidity; however, these figures reflect a time when comprehensive operations were the standard of care and they carry a higher associated morbidity than a SND . Thus, it is argued that the reduced morbidity of a SND should reduce the threshold for intervention, with Dziegielewski et al suggesting that a 5% or greater rate of occult metastasis be the threshold at which to dissect a clinically N‐negative neck or neck level . Considering level V in isolation, this review shows that the chance of occult disease in SCCN+V− would still fall under a 5% intervention threshold.…”

“…Studies have endeavored to determine the risk factors for metastasis to level V, and a wide range of these have emerged. The most commonly identified risk factor for nodal disease in level V is multiple positive nodes in other levels . In studies by Dziegielewski et al and Lim et al, patients determined to be clinically N2b or greater were significantly more likely to have disease in level V .…”

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“…Traditionally, successful treatment and better prognosis often depended on tumour staging, local extension, anatomical tumour site, histotype, lymph node involvement and locoregional disease control [3][4][5][6].…”