There is uncertainty regarding the threshold for recommending elective regional nodal treatment in the management of stage N0 cutaneous squamous cell carcinoma of the head and neck (cSCCHN). Elective treatment in the form of nodal surgery or irradiation is associated with morbidity. However, patients managed with careful observation sometimes present with advanced disease which often require more extensive therapy or may be unsalvageable altogether. We used decision analysis to examine the tradeoffs and benefits of different management approaches in the stage N0 patient. A decision tree comprising the three different treatment strategies was built: surveillance, elective nodal dissection (END) and elective nodal irradiation (ENI). Probabilities of nodal recurrence and likelihood of successful salvage were obtained from the literature. A convenience sample of patients previously treated for metastatic and non-metastatic cSCCHN was interviewed using the standard gamble technique to determine utility for post-treatment health states. Sensitivity analysis was performed and the effect on the expected utility was examined. When the probability of occult metastasis was >19 %, ENI resulted in a higher expected utility than observation. When the probability of occult metastasis exceeds 25 %, END has a higher expected utility compared to observation. Given the current available evidence, a wait-and-see approach is justified in patients with a probability of occult metastases <19 %.
Parotidectomy remains the mainstay of treatment for both benign and malignant lesions of the parotid gland. There exists a wide range of possible surgical options in parotidectomy in terms of extent of parotid tissue removed. There is increasing need for uniformity of terminology resulting from growing interest in modifications of the conventional parotidectomy. It is, therefore, of paramount importance for a standardized classification system in describing extent of parotidectomy. Recently, the European Salivary Gland Society (ESGS) proposed a novel classification system for parotidectomy. The aim of this study is to evaluate this system. A classification system proposed by the ESGS was critically re-evaluated and modified to increase its accuracy and its acceptability. Modifications mainly focused on subdividing Levels I and II into IA, IB, IIA, and IIB. From June 2006 to June 2016, 126 patients underwent 130 parotidectomies at our hospital. The classification system was tested in that cohort of patient. While the ESGS classification system is comprehensive, it does not cover all possibilities. The addition of Sublevels IA, IB, IIA, and IIB may help to address some of the clinical situations seen and is clinically relevant. We aim to test the modified classification system for partial parotidectomy to address some of the challenges mentioned.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.