The value of elective neck dissection in treatment of cancer of the tongue

Kaya, Sefa; Yılmaz, Taner; Gürsel, Bülent; Saraç, Sarp; Sennaroḡlu, Levent

doi:10.1053/ajot.2001.20681

Cited by 61 publications

(41 citation statements)

References 36 publications

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“…Therefore, our results supported the use of salvage surgery as the best means of salvaging regional recurrence and did not indicate any advantage of elective neck dissection for the primary treatment of N0 neck in early OTSCC. This outcome compares very favorably with those reported in previous studies [52,53]. It seems that this outcome was due to our management of the regional area through early diagnosis and adequate salvage surgery.…”

Section: Discussionsupporting

confidence: 86%

“…As expected, once regional recurrence appears, prognosis is poor and there are few long-term survivors. Some previous studies showed that the salvage rate for patients with regional recurrence of early-stage OTSCC was extremely low, regardless of the size of the lesion, the status of the cervical nodes, and the treatment used for the recurrence [52,53], whereas our study showed that salvage surgery was performed in 88.9% (8/9 patients) and 7 of the nine patients were salvageable, with a 77.8% salvage rate. Therefore, our results supported the use of salvage surgery as the best means of salvaging regional recurrence and did not indicate any advantage of elective neck dissection for the primary treatment of N0 neck in early OTSCC.…”

Section: Discussioncontrasting

confidence: 60%

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Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Yanamoto

Yamada

Takahashi

et al. 2013

Pathol. Oncol. Res.

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Locoregional recurrence of oral tongue squamous cell carcinoma (OTSCC) has been considered a poor prognostic entity in terms of survival rate.The purpose of this study was to evaluate the incidence of locoregional recurrence and to identify significant risk factors for locoregional recurrence in early-stage OTSCC. We retrospectively reviewed the records of 58 patients who underwent radical surgery for T1-2N0 OTSCC. The local recurrence and regional recurrence rates were 10.3% (6/58 patients) and 15.5% (9/58 patients) in this study, respectively. The survival rate of patients with local recurrence was 66.7%, which was significantly lower than that (96.2%) of patients without local recurrence, whereas the survival rates of patients with or without regional recurrence were not significantly difference. Pattern of invasion (POI), neoadjuvant chemotherapy (NAC) and the status of the surgical margin were identified as factors influencing local recurrence. In particular, the status of the deep surgical margin was a high potential independent risk factor. The deep surgical margin was resected closely in many NAC-treated cases, suggesting that NAC may lead to local recurrence and a poor outcome. No efficacy of NAC was observed, suggesting that the standard treatment for early OTSCC is surgery alone.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 60%

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Yanamoto

Yamada

Takahashi

et al. 2013

Pathol. Oncol. Res.

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“…

1Approximately 30% of patients with cN0 disease have nodal metastasis found by pathology (pNϩ), [1][2][3][4][5] with poor prognosis, particularly if there is extracapsular spread. 6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater.

9 Neck dissection provides nearly definitive information about nodal metastasis.

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confidence: 99%

Gene Expression Analysis As a Tool in Early-Stage Oral Cancer Management

Mroz

Rocco

2012

JCO

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Elective neck dissection for clinically stage N0 (cN0) disease has been called the gold standard in the management of early-stage oral squamous cell cancer (OSCC), despite advances in imaging technologies and the recent application of sentinel lymph node mapping. 1Approximately 30% of patients with cN0 disease have nodal metastasis found by pathology (pNϩ), [1][2][3][4][5] with poor prognosis, particularly if there is extracapsular spread. 6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater.9 Neck dissection provides nearly definitive information about nodal metastasis. If no positive nodes are found, there is little risk of regional recurrence.5-10 Elective neck dissection alone can often represent sufficient treatment for early-stage disease, while guiding the use of adjuvant radiation and chemotherapy when indicated. Nevertheless, with approximately 70% of cN0 cases also pN0, elective neck dissection raises concern over unnecessary surgery and its associated morbidity.11 Thus, some clinicians instead recommend watchful waiting, hoping to detect and treat any nodal metastasis quickly, 2 whereas others argue that the potential therapeutic benefit of neck dissection outweighs the risk of morbidity.1 Consequently, interest in solving this clinical treatment dilemma has prompted continued investigation into novel ways to improve the management of the cN0 neck in early-stage OSCC.In the article that accompanies this editorial, van Hooff et al 12 report major advances toward a primary-tumor RNA expression signature to help in this choice. With a laboratory-made microarray, this group had previously identified genes whose expression levels in primary oral-cavity tumors were related to nodal metastasis. 13,14 They now have moved their analysis platform to a commercial microarray in a Clinical Laboratory Improvement Amendments/International Organization for Standardization-approved laboratory, finding a gene-expression signature-score cutoff in a "platform transition" cohort that provided 92% negative predictive value in cT1-T2N0 cases (ie, 92% of cases with negative expression signatures were actually metastasis free, based on pathologic evaluation of the neck dissection). They then used that signature cutoff to classify a "validation" cohort of 222 specimens from eight institutions, finding 89% negative predictive value and 86% assay sensitivity for detecting pNϩ cases. Major challenges, however, remain in incorporating these promising technical results into clinical practice.A major reason for Van Hooff et al's successful extension of earlier findings to the more clinically relevant setting of their study is the large number of diagnostic genes-696 genes, with a total of 732 microarray probe sequences-whose primary-tumor expression levels were used quantitatively. The risk of nodal metastasis for each patient was gauged by how closely each of its 732 expression values matched the correspo...

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“…The intraoperative N staging sensitivity was determined to be 76.5%, and the specificity was 51.2%; furthermore, it was claimed that all preoperatively performed examinations failed to completely exclude lymph node metastases, and elective neck dissection was recommended even in early stage patients (20,21). Also, in the study conducted by Yılmaz et al (10), 65.9% of patients were reported as clinically N0, 55.7% were pathologically N0, and 44.3% were pathologically N+.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Correlation Between Prognostic Factors and Long-Term Mortality in Tongue Cancers

Kubat¹,

Beton²,

Gerçeker³

2016

Istanbul Med J

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The incidence of head and neck cancer is increasing in many parts of the world. Oral cavity cancer comprises approximately 3% of all types of cancer, and tongue cancer is the most common type of oral cavity cancer (1). Because a reliable epidemiological study has not yet been conducted, it is not possible to give a clear description of this subject in our country. Although head and neck cancer is usually diagnosed in the sixth decade of the patient's life, the prevalence among young patients (younger than 40 years) is increasing (2). Tongue cancer is more common in men; however, due to an increase in tobacco use, some studies have reported that the incidence of tongue cancer has increased among women as well.90% of the etiological factors of tongue cancer are associated with cigarettes, cigars, pipes, tobacco use, passive smoking, and alcohol consumption. Human papilloma virus (HPV) is also an infectious agent whose carcinogenic effects have been well proven (3). Other etiological factors are suppression of the immune system due to human immunodeficiency virus (HIV), long-term trauma secondary to the long-term use of inappropriate dentures, and poor oral hygiene.Squamous cell carcinoma (SCC) represents over 90% of oral cavity and tongue cancer cases (4). Premalignant lesions are classified as leukoplakia, erythroplakia, oral submucosal fibrosis, and oral lichen planus; studies conducted on this subject state that 6.6%-36.4% of premalignant lesions progress to invasive carcinoma within 1.5-8.5 years. Compared to leukoplakia, erythroplakia has a higher risk of malignancy (5).The tumor stage, histopathologic stage, growth pattern, lymph nodes in the neck and distant metastasis, and classification of the tumor as secondary or primary are important factors in determining the prognosis and survival in neck cancer cases. In cases of squamous cell carcinoma of the tongue, lymph node metastasis in the neck is quite common, and patients clinically diagnosed with non-metastatic lymph nodes in the neck (N0) have a high rate of occult metastasis.After histopathological diagnosis, for staging, computed tomography (CT) and/or magnetic resonance imaging (MRI) should be performed. Positron emission tomography (PET) is used in the determination of distant metastases in advanced stage disease (6).The choice of treatment varies depending on the status of the primary tumor and locoregional lymph node involvement. Surgery and radiotherapy (RT) can be applied as primary treatments The Effect of Correlation Between Prognostic Factors and Long-Term Mortality in Tongue CancersObjective: The aim of this study was to review demographic data, prognostic factors, and the effect on mortality of patients who were treated for tongue cancer and followed up at our clinic.Methods: Data between 2000 and 2013 were retrospectively reviewed. This report includes data from 96 patients. Demographic data, dental prostheses, smoking and drinking habits, CVs, tumor characteristics, treatment methods, recurrence, distant metastasis, second primary tumor pre...

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The value of elective neck dissection in treatment of cancer of the tongue

Cited by 61 publications

References 36 publications

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Gene Expression Analysis As a Tool in Early-Stage Oral Cancer Management

The Effect of Correlation Between Prognostic Factors and Long-Term Mortality in Tongue Cancers

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