Radical neck dissection: is it still indicated?

Hamoir, Marc; Silver, Carl E.; Schmitz, Sandra; Takes, Robert P.; Rinaldo, Alessandra; Rodrigo, Juan P.; Robbins, K. Thomas; Pitman, Karen T.; Medina, Jesús E.; Ferlito, Alfio

doi:10.1007/s00405-012-2237-7

Cited by 15 publications

(9 citation statements)

References 34 publications

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“…Originally the radical neck dissection (RND) consists of removal of all the lymphatic as well as non-lymphatic structures from the mastoid process down to the clavicle except the carotid artery, brachial plexus, hypoglossal, lingual, vagus, and phrenic nerves [ 8 , 9 ], which demands heavy burden to patients. Later on, selective neck dissection (SND) was introduced which preserved one or more lymph node levels [ 10 ] and the development of common terminology of discriminating neck levels which was well-known as the classification of American Head and Neck Society (AHNS) followed [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Patterns of recurrence after selective postoperative radiation therapy for patients with head and neck squamous cell carcinoma

et al. 2016

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BackgroundThe radiation field for patients with postoperative head and neck squamous cell carcinoma is narrower in our institution than in Western countries to reduce late radiation related toxicities. This strategy is at a risk of loco-regional or distant metastasis. However, because patients are more closely checked than in Western countries by every 1 to 2 months intervals and it is supposed that regional recurrences are identified and salvage surgeries are performed more quickly. Therefore, it is considered that patient survival would not be compromised with this strategy. The aim of this study was to investigate the feasibility of this strategy retrospectively.MethodsPatients who underwent neck dissection with close or positive margin, extra-capsular spread (ECS), multiple regional lymph node metastasis, pT4, with or without primary tumor resection were treated with postoperative radiation therapy. The volume of radiation field, especially the coverage of prophylactic regional lymph node area, was discussed among head and neck surgeons and radiation oncologists taking into account the clinical factors including patient’s age, performance status, number of positive lymph nodes, size of metastatic lymph nodes, extension of primary tumor beyond the midline, and existence of ECS.ResultsSeventy-two patients were identified who were treated with postoperative radiation therapy for head and neck squamous cell carcinoma between November 2005 and December 2014. There were 20 patients with oropharynx, 19 with hypopharynx, 7 with larynx, 23 with oral cavity, and 3 with other sites. Thirty eight patients had their neck irradiated bilaterally and 34 unilaterally. Median follow-up period for patients without relapse was 20.7 months (5.1–100.7). Thirty two patients had disease relapse after treatment including 22 loco-regional recurrence and 14 distant metastases. Among 22 loco-regional recurrence, seven patients underwent salvage surgery and one of them was no relapse at the time of the analysis. Among patients without bilateral neck lymph node metastasis who were treated with unilateral neck irradiation, patients with oral cavity or recurrent disease had significantly lower DFS compared with those without (2-y DFS 41.7 % vs 88.2 %, p = 0.017).ConclusionsIn patients without bilateral neck lymph node involvement, the postoperative unilateral neck irradiation is a reasonable treatment strategy for patients with the exception of oral cavity or recurrent disease.

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Section: Introductionmentioning

confidence: 99%

Patterns of recurrence after selective postoperative radiation therapy for patients with head and neck squamous cell carcinoma

et al. 2016

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“…The modified radical neck dissection, developed in the 1960s, also called a comprehensive dissection of all lateral lymph node levels, began to replace the standard radical neck dissection. Until recently, the radical and modified radical neck dissections were considered as the necessary and correct treatment for the surgical management of lymph node metastases of HNSCC . However, in many cases of clinically positive neck, a radical or modified radical neck dissection turns out to be overtreatment because not all of the palpable or detectable nodes are pathologically positive and not all (sub)levels of the neck are involved .…”

Section: Introductionmentioning

confidence: 99%

Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma

et al. 2014

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Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach.

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“…Les caractéristiques initiales des patients n'étaient pas statistiquement différentes entre les deux groupes. Le recul médian était de 60,1 [3, mois. L'incidence des échecs ganglionnaires était plus élevée chez les patients n'ayant pas eu de CGC (p=0,015).…”

Section: Résultatsunclassified

“…Historiquement, les rechutes ganglionnaires des carcinomes épidermoïdes de l'oropharynx pouvaient survenir dans 30% des cas environ après chimio-radiothérapie (CRT) [2]. Ainsi, selon les équipes, un curage ganglionnaire cervical peut être pratiqué comme traitement de première intention des carcinomes épidermoïdes de la tête et du cou (CETC) localement avancés, indépendamment des caractéristiques de la tumeur primitive, d'autant que les progrès des techniques chirurgicales, avec notamment la réalisation d'un curage ganglionnaire radical modifié, ont considérablement réduit la morbidité de ce geste [3]. Toutefois, un essai randomisé de phase III a récemment démontré que l'imagerie fonctionnelle par tomographie à émission de positons couplée au [18F] flurodéoxyglucoce (TEP-FDG) était efficiente pour évaluer la réponse thérapeutique dans les stratégies basées sur la CRT première dans les CETC N2-3 [4].…”

Section: Introductionunclassified

“…La deuxième complication la plus fréquente était la dysgueusie avec une incidence tous grades confondus de 29,7% (IC95% ) à 6 mois, 19,4% (IC95% ), 12,5% (IC95% [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]) et de 11,6% (IC95% ) sans aucune différence en fonction de la stratégie thérapeutique. L'incidence de la dysphagie tous grades confondus était de 28,4% (IC95% ) à 6 mois, 16,7% (IC95% [9-27]) à 12 mois, 6,3% (IC95% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]) à 24 mois et 11,6% (IC95% [4-25]) à 5 ans. Les taux de dysphagie ne différaient pas significativement chez les patients opérés ou non (Figure 1B).…”

Section: Introductionunclassified

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Impact du curage ganglionnaire cervical dans la prise en charge par chimioradiothérapie exclusive des cancers de l’oropharynx de stade N2-3 : étude observationnelle en vie réelle

Klausner

Troussier

Kreps³

et al. 2021

Cancer/Radiothérapie

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Radical neck dissection: is it still indicated?

Cited by 15 publications

References 34 publications

Patterns of recurrence after selective postoperative radiation therapy for patients with head and neck squamous cell carcinoma

Patterns of recurrence after selective postoperative radiation therapy for patients with head and neck squamous cell carcinoma

Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma

Impact du curage ganglionnaire cervical dans la prise en charge par chimioradiothérapie exclusive des cancers de l’oropharynx de stade N2-3 : étude observationnelle en vie réelle

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