Management Implications of Evaluating the N2 and N3 Neck After Organ Preservation Therapy

Strasser, Mark D.; Gleich, Lyon L.; Miller, Mary Ann; Saavedra, Harold I.; Gluckman, Jack L.

doi:10.1097/00005537-199911000-00010

Cited by 45 publications

(38 citation statements)

References 21 publications

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“…However, the actual rate of neck recurrences is, in fact, lower than the rate of positive histologic findings in neck dissection specimens (36). In part, this may reflect limitations of histopathologic analysis: The mere presence of residual cancer cells in lymph nodes by standard hematoxylin-eosin analysis may not predict whether these residual cells are also capable of growth and multiplication (37), which ultimately determines the rate of clinical recurrence. Finally, surgical intervention in the pretreated neck is not a completely innocuous procedure, with complication rates ranging between 5% and 35% (22,34).…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Ong

Schöder²,

Lee³

et al. 2008

J Nucl Med

249

188

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Section: Discussionmentioning

confidence: 99%

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Ong

Schöder²,

Lee³

et al. 2008

J Nucl Med

249

188

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“…7,18 An experimental study, examining a proliferation marker, Ki-67, appears to confirm this hypothesis. 20 Accuracy of PET-CT scanning in the assessment of response to chemoradiotherapy and detection of residual nodal disease…”

Section: 14mentioning

confidence: 99%

PET-NECK: a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomography–computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer

Mehanna

McConkey

Rahman

et al. 2017

Health Technol Assess

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a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomographycomputerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer. Health Technol Assess 2017;21(17). This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). Health Technology Assessment is indexed and abstracted inEditorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 06/302/129. The contractual start date was in April 2007. The draft report began editorial review in July 2015 and was accepted for publication in June 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily ref...

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“…The majority of surgically treated patients only had a lymph node excision performed which increases the risk that a truly residual cancer was missed. Moreover, prior studies have indicated that residual carcinoma in neck dissection specimens following radiotherapy may not always be biologically viable, and so neck failure rate may be overestimated among surgically treated patients [9]. Furthermore, it is possible that not all patients in this cohort had truly node-positive disease, as this classifi cation was based on clinical and radiological fi ndings.…”

Section: Discussionmentioning

confidence: 97%

Response evaluation of the neck in oropharyngeal cancer: Value of magnetic resonance imaging and influence of p16 in selecting patients for post-radiotherapy neck dissection

et al. 2015

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Background. Residual neck disease after radiotherapy in advanced oropharyngeal squamous cell carcinoma (OPSCC) is associated with increased mortality, and some patients may benefi t from post-radiotherapy neck dissection (PRND). The aim of the present study was to assess the value of magnetic resonance imaging (MRI) and other clinical characteristics in selecting patients for PRND. Materials and methods. Retrospective cohort study. Consecutive patients with N ϩ OPSCC were included. Medical records, pathology reports and imaging reports were reviewed. Pre-and post-therapeutic imaging was re-evaluated. Results. A total of 100 consecutive patients from a three-year period were included. Neck response was evaluated with MRI two months after treatment. Sixty patients were suspicious for residual neck disease, and were offered surgery; seven of these patients had histologic evidence of carcinoma. Cumulative neck failure after three years was 14% (8.4 -24%), and did not differ signifi cantly among patients with positive compared to negative MRI (radiologist ' s initial description; p ϭ 0.47, log-rank test). Applying neck failure as gold standard, sensitivity and specifi city of MRI was 69% and 41%, respectively; positive and negative predictive value was 15% and 90%. Patients with p16 ϩ disease had signifi cantly larger lymph nodes after treatment, and imaging based on lymph node size resulted in many false positives. Analysis of receiver operating characteristic curves in 191 individual lymph nodes showed that a short axis Ն 10 mm should be classifi ed as suspicious. Furthermore, T-stage and p16-status were associated with increased risk of neck recurrence. Salvage was successful in four patients with early detected nodal recurrence. Conclusion. These results suggest that lymph node size, T-stage and p16 status could be used in selecting patients for PRND in OPSCC. Yet, early anatomical imaging may be inappropriate for evaluating neck response in patients with p16 ϩ disease as enlarged lymph nodes often do not indicate residual neck disease.

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Management Implications of Evaluating the N2 and N3 Neck After Organ Preservation Therapy

Abstract: The discovery of proliferating cancer cells in 3 of 17 irradiated specimens (18%) supports the practice of planned neck dissection after primary radiotherapy for patients with pretherapeutic N2+ metastatic disease.

Cited by 45 publications

References 21 publications

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Response evaluation of the neck in oropharyngeal cancer: Value of magnetic resonance imaging and influence of p16 in selecting patients for post-radiotherapy neck dissection

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Management Implications of Evaluating the N2 and N3 Neck After Organ Preservation Therapy

Abstract: The discovery of proliferating cancer cells in 3 of 17 irradiated specimens (18%) supports the practice of planned neck dissection after primary radiotherapy for patients with pretherapeutic N2+ metastatic disease.

Cited by 45 publications

References 21 publications

Clinical Utility of18F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Clinical Utility of18F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Response evaluation of the neck in oropharyngeal cancer: Value of magnetic resonance imaging and influence of p16 in selecting patients for post-radiotherapy neck dissection

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Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

Clinical Utility of¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer