Indication of elective contralateral neck dissection in squamous cell carcinoma of the hypopharynx

Amar, Ali; Dedivitis, Rogério Aparecido; Rapoport, Abrão; Quarteiro, André Luiz

doi:10.1590/s1808-86942009000400004

Cited by 10 publications

(4 citation statements)

References 12 publications

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“…Data from multiple pathological studies [35][36][37][38][39][40] showed that metastases form clinically N0 hypopharyngeal cancer rarely occur in levels I and IIB, and they supported the recommendation to preserve levels I and IIB in these patients, which may improve the post-operative functional outcome, particularly with regard to the spinal accessory nerve and future shoulder function [41]. Contralateral nodal clearance may also be considered in the at-risked group of patients, including those with tumor involving the medial wall of the pyriform recess [42][43][44][45], post-crioid region or the posterior wall [43,[46][47][48], and those with ipsilateral palpable nodal metastasis and clinical stage IV disease.…”

Section: Management Of the Neckmentioning

confidence: 89%

Current management strategy of hypopharyngeal carcinoma

2013

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Section: Management Of the Neckmentioning

confidence: 89%

Current management strategy of hypopharyngeal carcinoma

2013

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“…As a consequence of better diagnostic imaging, the risk assessment for contralateral nodal involvement probably also changes. Tumors approaching the midline, advanced T-stage and (multiple) ipsilateral nodal metastases are known risk-factors for contralateral nodal involvement in head and neck cancer [48][49][50][51][52][53][54]. Due to increased diagnostic accuracy, also the indications for elective irradiation of contralateral nodal areas need refinement with the likely result that more patients can be spared the morbidity of bilateral neck treatment.…”

Section: Head and Neck Cancermentioning

confidence: 99%

Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer: Radiotherapy target volume transformation and dose de-escalation

Bosch

Vogel

Raaijmakers

et al. 2018

Radiotherapy and Oncology

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Diagnostic imaging continues to evolve, and now has unprecedented accuracy for detecting small nodal metastasis. This influences the tumor load in elective target volumes and subsequently has consequences for the radiotherapy dose required to control disease in these volumes. Small metastases that used to remain subclinical and were included in elective volumes, will nowadays be detected and included in high-dose volumes. Consequentially, high-dose volumes will more often contain low-volume disease. These target volume transformations lead to changes in the tumor burden in elective and "gross" tumor volumes with implications for the radiotherapy dose prescribed to these volumes. For head and neck tumors, nodal staging has evolved from mere palpation to combinations of high-resolution imaging modalities. A traditional nodal gross tumor volume in the neck typically had a minimum diameter of 10-15 mm, while nowadays much smaller tumor deposits are detected in lymph nodes. However, the current dose levels for elective nodal irradiation were empirically determined in the 1950s, and have not changed since. In this report the radiobiological consequences of target volume transformation caused by modern imaging of the neck are evaluated, and theoretically derived reductions of dose in radiotherapy for head and neck cancer are proposed. The concept of target volume transformation and subsequent strategies for dose adaptation applies to many other tumor types as well. Awareness of this concept may result in new strategies for target definition and selection of dose levels with the aim to provide optimal tumor control with less toxicity.

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“…There is a high incidence of advanced cases already found upon initial presentation compared to other sites of the head and neck, such as the larynx 6 , having distant metastases, and especially regional metastases - which may be the first clinical manifestation of the disease 7 . Data from the Department of Health shows that 23% of patients are in clinical stage III and 72% in stage IV 4 - which causes these patients to have a median five-year survival by disease stage of 56% and 32%, respectively 4 .…”

Section: Introductionmentioning

confidence: 99%