Role of Planned Postchemoradiotherapy Selective Neck Dissection in the Multimodality Management of Head and Neck Cancer

Nouraei, S.A.R.; Upile, Tahwinder; Al‐Yaghchi, Chadwan; Lei, Mary; Sandhu, Guri; Stewart, Simon; Clarke, Peter; Sandison, Ann

doi:10.1097/mlg.0b013e318165e33e

Cited by 30 publications

(33 citation statements)

References 14 publications

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“…The high overall regional control rate of 95 % in the PND group was in line with the literature [26][27][28]. Although not statistically significant, the overall regional control rate in the SND group was with 87 % lower.…”

Section: Discussionsupporting

confidence: 90%

No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression

Maquieira

Haerle

Huber

et al. 2015

Eur Arch Otorhinolaryngol

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The aim of the study was to assess regional control and survival in primary irradiated oropharyngeal cancer patients with advanced neck disease (≥cN2a) receiving planned neck dissection (PND) irrespective of the nodal response compared to salvage neck dissection (SND) in case of regional persistence or reccurence in relation to tumoral p16 overexpression. 96 consecutive patients treated at the University Hospital of Zurich, Switzerland were included. Tissue microarray-based scoring of p16 expression was obtained. 5 years overall (OS) and disease-specific survival (DSS) in the PND and SND cohort were 70 vs. 57 % (p = 0.20) and 80 vs. 65 % (p = 0.14), respectively. Regional control in PND and SND achieved 95 vs. 87 % (p = 0.29), respectively. There was no statistically significant impact of neck treatment (PND vs. SND) on regional control or survival among patients with p16-negative tumors (5 years OS 59 vs. 50 %, p = 0.66; 5 years DSS 59 vs. 57 %, p = 0.89) nor among patients with p16-positive tumors (5 years OS 84 vs. 67 %, p = 0.21; 5 years DSS 95 vs. 81 %, p = 0.24). The type of neck dissection after primary intensity-modulated radiotherapy (IMRT) had no impact on regional control and survival even in human papillomavirus (HPV)-associated disease. Therefore we are convinced that based on the accuracy of newer diagnostic modalities the surveillance of a radiologically negative neck after primary chemoradiation (CRT) is oncologically safe irrespective of p16 expression of the tumor.

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Section: Discussionsupporting

confidence: 90%

No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression

Maquieira

Haerle

Huber

et al. 2015

Eur Arch Otorhinolaryngol

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“…This trend of planned ND was widely used as no modalities for the evaluation of nodal response had yet been developed. Some authors using planned ND reported good nodal control rates and revealed frequent residual nodal metastases in surgical specimens [9][10][11]. Therefore they supported the use of planned ND following radiotherapy.…”

Section: Discussionmentioning

confidence: 55%

Regional control after concomitant chemoradiotherapy without planned neck dissection in node-positive head and neck squamous cell carcinomas

et al. 2013

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dissection in node-positive head and neck squamous cell carcinomas. AbstractObjectives: Although three-weekly high-dose (100mg/m 2 ) cisplatin (three cycles) chemoradiotherapy has been considered a standard regimen for patients with advanced head and neck squamous cell carcinomas (HNSCC), this protocol is associated with significant acute and late toxicities. Therefore, weekly cisplatin at a dose of 40mg/m 2 has been used at our institution since 2006. This retrospective study was aimed at assessing the oncologic efficacy of weekly cisplatin chemoradiotherapy for the control of nodal metastasis.Methods: We analyzed 28 patients with node-positive HNSCC treated with weekly cisplatin and concurrent radiotherapy. Computed tomography was performed 4-8 weeks after the completion of chemoradiotherapy to evaluate nodal response. If residual neck disease was apparent or suspected, we performed early salvage neck dissection (ND). In cases with a complete response (CR), we took a " wait and see " approach.When no viable tumor cells were observed in the surgical specimens obtained by ND, nodal metastasis was defined as controlled by weekly cisplatin chemoradiotherapy alone.Results: Nodal metastasis was evaluated as having a CR in 20 patients (71%). Eight patients (29%) underwent early salvage ND. Recurrent primary tumors were observed in the other four patients (14%). Salvage primary resection and associated ND were performed for these four patients.In 7 of 12 patients undergoing ND, no viable tumor cells were observed. In 23 of 28 patients, neck diseases were controlled by chemoradiotherapy alone (not including salvage by ND). In 27 of 28 patients, neck diseases were controlled by the overall treatment (including salvage by ND). The rate of nodal control by chemoradiotherapy alone and by the overall treatment was found to be 82.0% and 96.3%, respectively, using the Kaplan-Meier method.The three-year overall and disease free survival rates were 86.8% and 80.8%, Although three-weekly high-dose (100mg/m 2 ) cisplatin (three cycles) and radiotherapy has been considered a standard regimen for patients with advanced HNSCC, this protocol is associated with significant acute and late toxicities [1][2][3][4]. Furthermore, the completion rate for this regimen is relatively poor [1][2]. Therefore, weekly cisplatin at a dose of 40mg/m 2 has been used at our institution since 2006. We reported that weekly cisplatin was easier to manage than three-weekly cisplatin, because patients could be monitored more regularly for toxicity, thereby allowing the schedule to be altered if required [5]. This retrospective study was aimed at assessing the oncologic efficacy of concomitant weekly cisplatin chemoradiotherapy without planned neck dissection (ND) for the control of neck disease. MATERIAL AND METHODSPatients. Between July 2006 and May 2011, 59 patients with biopsy-proven HNSCC were treated with concurrent weekly cisplatin chemoradiotherapy. Twenty-two patients with N0, seven patients who underwent neo-adjuvant chemotherapy (using cisplatin,...

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“…Nouraie et al and Simon both find that persistent disease is the only independent predictor of regional control and disease-specific survival. 1,14 In other words, viable posttreatment cancer in the specimen is associated with poor survival; whether or not neck dissection impacts this decreased survival remains to be seen. From these prior studies and our current study, it may logically follow that poorly compliant patients are at significantly higher risk of persistent neck disease, hence decreasing disease specific survival.…”

Section: Discussionmentioning

confidence: 98%

“…While the majority of articles show that neck dissection is safe and effective, Nouraei, et al noted a 20% major postoperative complication rate including swallowing deterioration, perioperative cardiac dysfunction, wound infection with bleeding, unplanned postoperative tracheotomy, perioperative sepsis, and shoulder morbidity requiring an Eden-Lange procedure. 1 While it is generally safe and often times necessary to perform postchemoradiation neck dissections, this surgery may incur morbidity. Accordingly, it would be ideal to develop a strategy to accurately predict which patients are most likely to harbor residual disease, and perhaps most benefit from neck dissection.…”

Section: Discussionmentioning

confidence: 99%

“…As a matter of practice for some surgeons, neck dissection is performed on patients initially staged as N2a or greater, even when complete resolution of neck disease is observed clinically and radiographically on computed tomography. 1 When treated in this fashion, studies have shown the incidence of persistent neck disease after treatment with chemoradiotherapy ranges from 20% to 40% as noted on pathologic exam of neck specimens. 2 While identification of patients with persistent disease upon neck dissection may yield prognostic information, the therapeutic benefit of such neck dissection is not firmly established.…”

Section: Introductionmentioning

confidence: 97%

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Poor radiotherapy compliance predicts persistent regional disease in advanced head/neck cancer

et al. 2009

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This study found that poorly compliant patients are at significantly higher risk of persistent neck disease. Poor compliance may help identify patients who will most benefit from neck dissection after chemoradiation. This variable was more predictive than pretreatment variables and posttreatment CT scan. Further studies investigating patterns of failure after chemoradiotherapy in the poorly compliant patient population are warranted.

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Role of Planned Postchemoradiotherapy Selective Neck Dissection in the Multimodality Management of Head and Neck Cancer

Cited by 30 publications

References 14 publications

No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression

No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression

Regional control after concomitant chemoradiotherapy without planned neck dissection in node-positive head and neck squamous cell carcinomas

Poor radiotherapy compliance predicts persistent regional disease in advanced head/neck cancer

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