Planned Neck Dissection before Combined Chemoradiation in Organ Preservation Protocol for N2-N3 of Supraglottic or Hypopharyngeal Carcinoma

Abstract

Objective: To investigate the clinical therapeutic outcomes and neck node control of a pretreatment neck dissection in the chemoradiation protocol of organ preservation for N2-N3 of supraglottic and hypopharyngeal carcinoma. Methods: Forty-six patients (group A) with untreated N2 or N3 squamous cell carcinoma of the supraglottis or hypopharynx underwent pretreatment neck dissection in a chemoradiation protocol, while 39 patients (group B) did not undergo pretreatment neck dissection in a chemoradiation protocol. Salvage surgeries were used for local or cervical node residual tumor or recurrence after chemoradiotherapy. Results: In group A, the mean time between neck dissection and chemoradiation was 21 days (range 15-29). Only 3 patients (6.5%) experienced wound complications. A ‘boost' of radiation of 12 Gy was delivered after 33 neck dissections (64.8%) in patients with extracapsular spread. The Kaplan-Meier 5-year overall survival rate was 42.5%. The 5-year overall survival rate and disease-specific survival rate in group A was 42.5 and 46.4%. The rate of neck node control in group A was better than that in group B (86.3 vs. 65.9%, p = 0.02). Conclusions: Pretreatment neck dissection in a chemoradiation protocol for supraglottic or hypopharyngeal carcinoma showed low complication rates, no delay for radiation, optimal radiation doses, and a high nodal disease control.

Management of Advanced Laryngeal Cancer

“…For patients with large-volume neck disease which may be considered less likely to respond to radiotherapy, an alternative option is up-front neck dissection, followed by radiotherapy or chemoradiotherapy for treatment of the primary tumor and adjuvant treatment to the neck 74,75. This option may be particularly useful in patients with small primary tumors and bulky metastatic neck disease, as it may obviate the need of intensification of radiotherapy treatment with chemotherapy, provided there are no major adverse histological features (positive margins or gross extranodal extension) in the neck dissection specimen.…”

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.…”

“…Additionally, it has been shown in several studies that a ND after (C)RT increases the risk of delayed wound healing and other postoperative complications. Local and systemic complication rates after ND of the previously irradiated region varied from 5% to 77% [28][29][30][31][32], with severe late grade 3 toxicity reported as high as 55% [28,33].…”

“…The so called up-front ND (UFND) is currently less known and performed [6], but confers the advantages of avoiding adjuvant surgery on a previously irradiated neck as well as the removal of hypoxic tissues and bulky nodal metastases, which may be less responsive to (C)RT and possibly associated to an increased risk of distant metastases [34][35][36]. Satisfying control and postoperative complication rates with UFND, along with minimal delay of definitive treatment, have been reported previously [31,[37][38][39][40][41][42]. Despite the good results of UFND, many authors consider this approach as a redundant strategy, since definitive (C)RT will take place to the primary tumor site and the neck [25,43].…”

Advanced Laryngeal Cancer (Literature Review)

“…Для пациентов с большим распространением опухолевого процесса на шее, которые не всегда отвечают на радиотерапию, альтернативным вари-антом является передне-верхняя лимфодиссекция шеи с последующей лучевой или химиолучевой терапией [75]. Этот вариант лечения может быть применен при небольших первичных опухолях и обширном метастатическом поражении лимфатического аппарата на шее, поскольку это исключает необходимость интенсификации лучевой терапии и химиотерапии при отсутствии неблагоприятных гистологических признаков (положительные края резекции или экстранодальный рост) по данным исследования операционного материала.…”