PLANNED NECK DISSECTION FOR PATIENTS WITH COMPLETE RESPONSE TO CHEMORADIOTHERAPY: A CONCEPT APPROACHING OBSOLESCENCE

被引:56
作者
Ferlito, Alfio [1 ]
Corry, June [2 ]
Silver, Carl E. [3 ,4 ]
Shaha, Ashok R. [5 ]
Robbins, K. Thomas [6 ]
Rinaldo, Alessandra [1 ]
机构
[1] Univ Udine, Dept Surg Sci, ENT Clin, I-33100 Udine, Italy
[2] Peter MacCallum Canc Inst, Div Radiat Oncol, Melbourne, Vic 3000, Australia
[3] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Surg, Bronx, NY 10467 USA
[4] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Otolaryngol Head & Neck Surg, Bronx, NY 10467 USA
[5] Mem Sloan Kettering Canc Ctr, Head & Neck Serv, New York, NY 10021 USA
[6] So Illinois Univ, Sch Med, Div Otolaryngol Head & Neck Surg, Springfield, IL USA
来源
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK | 2010年 / 32卷 / 02期
关键词
head and neck cancer; squamous cell carcinoma; concurrent chemoradiation; neck dissection; neck management; planned neck dissection; SQUAMOUS-CELL CARCINOMA; CLINICALLY POSITIVE NECK; POSITRON-EMISSION-TOMOGRAPHY; LOCOREGIONALLY ADVANCED HEAD; ORGAN PRESERVATION THERAPY; RADIATION-THERAPY; POSTRADIOTHERAPY NECK; NODAL DISEASE; CONCURRENT CHEMORADIOTHERAPY; OROPHARYNGEAL CANCER;
D O I
10.1002/hed.21173
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
The question of efficacy of "planned" neck dissection following complete response to chemoradiation of head and neck cancer is discussed. There is general agreement that preemptive neck dissection in patients who present initially with low volume (N1) neck disease is not necessary. However, routine performance of planned neck dissection for patients who present initially with high volume (>= N2) disease remains controversial. The authors reviewed a large number of studies reported in the recent literature and discuss how they affect this debate. Twenty-four of the reviewed studies indicate a benefit in regional control obtained by "planned" neck dissection among patients who had bulky neck disease pretreatment. All these studies are retrospective, they do not assess treatment response prior to surgery, although they do show very good regional control rates. Twenty-six studies demonstrate no benefit from "planned" neck dissection after complete clinical response. The reasons for these different conclusions include the development of more effective chemoradiation regimens which have improved the initial locoregional control rates of patients undergoing primary chemoradiation treatment, and improvements in diagnostic technology which have increased ability to detect low volume persistent tumor in the post treatment period. When neck dissection is necessary for persistent or recurrent disease, recent studies have shown that selective or superselective neck dissection may produce results therapeutically equivalent to those obtained with more extensive procedures, with less morbidity. There is now a large body of evidence, based on long-term clinical outcomes, that patients who have achieved a complete clinical (including radologic) response to chemoradiation have a low rate of isolated neck failure, and the continued use of planned neck dissection for these patients cannot be justified. (C) 2009 Wiley Periodicals, Inc. Head Neck 32: 253-261, 2010
引用
收藏
页码:253 / 261
页数:9
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