Node‐positive hypopharyngeal cancer treated by (chemo)radiotherapy: Impact of up‐front neck dissection on outcome, toxicity, and quality of life

Abstract

Upfront neck dissection followed by (chemo)radiation did not negatively impact on oncologic outcomes, toxicity, or quality of life and therefore is to be regarded as a safe and effective treatment option for small HPC with bulky nodal disease, especially in busy radiation departments with unacceptably long waiting time for definitive (chemo)radiation.

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

“…The literature search yielded a total of 1131 articles and abstracts. Only 15 of those met all inclusion criteria and were considered for final analysis [31,[37][38][39][40][41][42][45][46][47][48][49][50][51][52]. A flowchart detailing the number of screened, included and excluded articles, as well as the reasons for exclusion is provided in Fig.…”

“…Treatment modalities for groups other than UFND had extreme variations through studies. Groups/arms other than UFND and (C)RT contained surgery to the primary tumor and ND with the addition of post-operative RT in one study [45] and (C)RT alone without planned ND in the remaining studies (Table 2) [31,42,45,49,51]. Salvage NDs were performed in case of less than complete clinical response or recurrence.…”

“…Two-dimensional conventional RT was reported in 5 studies [31,39,42,47,50]. Three-dimensional conformal and IMRT techniques were described in 3 studies [37,40,51]. Most of the study cohorts were treated in an era when the use of concomitant chemotherapy was not established as standard (published until 2001).…”

“…Post-UFND complications were reported in 13 studies. Eight of them reported total postoperative complication rates of less than 10% [31,37,38,41,42,46,50,51] whereas the remaining 5 studies showed complications between 12% and 37% [39,40,47,48,52]. Postoperative complications were assessed in 2 studies comparing strategies with and without UFND [31,42].…”

“…Six authors [31,39,41,45,49,50] did not mention toxicity and in the other 9 articles [37,38,40,42,[46][47][48]51,52] different scales or subjective evaluations were used. Percentage of ''serious" or grade P 3 toxicities ranged from 0% to 80% for acute [40,46,47,51,52] and 0-20% for late toxicities [37,38,40,42,[46][47][48]51] among cases treated with UFND strategy. Two authors compared grade P 3 toxicities among the groups treated with and without UFND: Allal et al [47] found no significant differences for acute (80% vs. 86%) and late toxicities (8% vs. 6%), whereas Al-Mamgani [51] reported significantly higher grade 3 acute toxicity in patients treated with Table 2 Description of studies with more than one arm.…”