Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral. Cavity results of a randomized clinical trial

Abstract

This study concerns 75 patients with squamous cell carcinoma of the oral cavity who were patients at the Gustave-Roussy Institute between December 1966 and July 1973. These patients were divided into two groups. The first group was comprised of 39 patients who underwent elective radical neck dissection; nodal involvement was present in 49% with capsular rupture in 13%. In the second group of 36, neck disease appeared during follow up in 19 cases. Therapeutic radical neck dissection was carried out in 17; the nodes were histologically positive in 15, 9 of which had a capsular rupture. In 2 cases, local or general conditions did not permit operative intervention. In this group, the involvement rate was 47% with a 25% capsular rupture rate. However, the comparison of the survival curves by the log-rank test did not reveal any differences, even though histologic prognostic factors were taken into account. These findings led to the conclusion that in squamous cell carcinoma of the oral cavity staged T1N0, T2N0, or T3N0 (from AJC's and UICC's clinical staging system), it seems possible, without risk, to delay neck dissection until a node is detectable, although it is reasonable to perform elective neck dissection in those cases in which the patient is unavailable for regular followup.

Surgical treatment of early oral carcinoma—Results of a prospective controlled multicenter study

“…In view of the considerable probability of occult metastases, Hicks, 12 Kligermann, 22 and Cunningham 11 consider the performance of an elective neck dissection to be essential. Conversely, Davidson, 24 Vandenbrouck, 25 and Ho 26 found no difference in survival between patients with and without elective neck dissection and hence favor a wait-and-see approach. Our own data show a significantly higher rate of cervical recurrence with no neck dissection but no relevant worsening of the survival probability and would therefore justify a wait-and-see approach.…”

To Operate or Not to Operate N0 Neck in Early Cancer of the Tongue? A Prospective Study

“…To date four randomized control trials (RCT) have been conducted to address this issue. Two of these included only cancer of the tongue [2,3] and the other two [4,5] have included other early cancers of the oral cavity. However, the results of these trials have not provided a satisfactory answer to the controversy.…”

How to Optimize Therapeutic Ratio in Brachytherapy of Head and Neck Squamous Cell Carcinoma?

“…If a postoperative external beam irradiation of the neck is delivered, the implanted area is protected by a cerrobend block. At the moment, despite a randomised trial comparing the two attitudes and showing similar results, there is no consensus on this point (55,56 …”