Neck management in head and neck squamous cell carcinomas: where do we stand?

Klausner, G.; Troussier, I.; Blais, E.; Carsuzaa, Florent; Zilli, Thomas; Miralbell, Raymond; Caparrotti, Francesca; Thariat, Juliette

doi:10.1007/s12032-019-1265-1

Cited by 15 publications

(16 citation statements)

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“…Head and neck squamous cancer encompasses a great variety of tumors originating in the oral cavity, oropharynx, hypopharynx, lip, nasopharynx, or larynx. A large proportion of patients with SCCHN debuts with a tumor at locally advanced stage (11).…”

Section: Discussionmentioning

confidence: 99%

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Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck

et al. 2020

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EGFR activation induces cell proliferation, neoformation of blood vessels, survival, and metastasis of the cancer cells. Nimotuzumab is an engineered, intermediate affinity anti-EGFR antibody, that apart from other drugs in its class, is very safe and does not cause hypomagnesemia or grade 3-4 cutaneous rash. The antibody inhibits cell proliferation and angiogenesis, activates natural killer cells, stimulates dendritic cell maturation, and induces cytotoxic T cells. Nimotuzumab restores MHC-I expression on tumor cells, hindering one of the EGFR immune-escape ways. The antibody has been extensively studied in 7 clinical trials, concurrently with irradiation or irradiation plus chemotherapy in subjects with inoperable head and neck tumors. Nimotuzumab was safe and efficacious in unfit patients receiving irradiation alone and in subjects treated with cisplatin and radiotherapy. In patients with locally advanced squamous cell carcinomas of the head and neck, nimotuzumab in combination with low dose cisplatin and radiotherapy was superior to cisplatin and radiotherapy in progression free survival, disease free survival, and locoregional tumor control.

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Section: Discussionmentioning

confidence: 99%

“…Overall, both treatment modalities can be considered equally effective for small tumors. Larger tumors usually require the combined use of both treatment options (11). Curative-intent therapy of stage III or IV SCCHN patients requires a multimodal approach.…”

Section: Introductionmentioning

confidence: 99%

Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck

et al. 2020

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“…Painful shoulder 7.9% (5) 10.7% (9) .570 33.1% (45) <.001 Tracheostomy 3.2% (2) 7% (6) .468 6.4% (9) .578…”

Section: Data Ava I L a B I L I T Y S Tat E M E N Tmentioning

confidence: 99%

“…Several studies have investigated whether neck dissection should be performed upfront or following chemoradiation. [1][2][3][4][5][6] A pivotal phase III trial recently showed that neck dissection can be omitted by use of positron emission tomography (PET)-computed tomography (CT) in N2-3 HNSCC, thus providing an adequate alternative to systematic upfront or post-chemoradiation neck dissection. 3 However, in this study, only a small proportion of the patients had N3 disease, and no conclusion could be drawn regarding the optimal timing of neck dissection and multimodal management of N3 nodes.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with head and neck squamous cell carcinoma (HNSCC) with a primary tumour of limited size, N3 disease is associated with a high risk of regional relapse and metastases. Several studies have investigated whether neck dissection should be performed upfront or following chemoradiation 1‐6 . A pivotal phase III trial recently showed that neck dissection can be omitted by use of positron emission tomography (PET)‐computed tomography (CT) in N2‐3 HNSCC, thus providing an adequate alternative to systematic upfront or post‐chemoradiation neck dissection 3 .…”

Section: Introductionmentioning

confidence: 99%

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Locoregional control, progression‐free survival and morbidity rates in N3 head and neck cancer patients with low primary tumour burden: A 301‐patient study

Carsuzaa¹,

Dufour²,

Gorphe

et al. 2020

Clinical Otolaryngology

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Objectives: In patients with N3 head and neck squamous cell carcinoma (HNSCC), N3 disease is associated with high regional relapse and metastatic risks. Patients with resectable N3 disease have better prognosis although their metastatic risk may be similar as in patients with unresectable disease. Neoadjuvant chemotherapy has been associated with lower metastatic rates, but N3 patients may die of rapid locoregional progression. We assessed outcomes with the three modalities in patients with low primary burden to better assess the specific prognosis of N3 disease. Methods: This retrospective multicentric study included T0-2 N3 HNSCC patients. Outcomes and morbidity in upfront neck dissection (uND) vs non-surgical groups were analysed and oncological outcomes and morbidity compared between patients undergoing chemoradiation or neoadjuvant chemotherapy in patients with initially unresectable N3 nodes. Results: Of 301 patients, 142 (47%) underwent uND, 68 (23%) neoadjuvant chemotherapy and 91 (30%) chemoradiation. The 24-and 60-month incidence of locoregional relapse was 23.2% [18.3%; 28.4%] and 27.4% [21.8%; 33.3%]; it was lower in patients undergoing uND (P = .006). In patients with non-surgical treatments, success rates were 57.8% [49.4%; 66.3%] after chemoradiation and 38.1% [29.6%; 46.7%] after neoadjuvant chemotherapy (P = .001). Overall morbidity was more frequent in patients undergoing uND (68.8%) (P < .001). Conclusion: uND improved locoregional control but increased morbidity and showed no survival benefit. Success rates were better after chemoradiation versus neoadjuvant chemotherapy. Neoadjuvant chemotherapy did not reduce metastatic rates but non-responders to chemoradiation had poor PFS and survival rate, suggesting that predictive criteria are warranted. How to cite this article: Carsuzaa F, Dufour X, Gorphe P, et al. Locoregional control, progression-free survival and morbidity rates in N3 head and neck cancer patients with low primary tumour burden: A 301-patient study. Clin Otolaryngol.

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The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma

Hsueh

Gong

et al. 2022

Head & Neck

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BackgroundFor patients with less chemosensitive neck nodes, poor prognosis after chemoradiotherapy (CRT) could be predicted and neck dissection is needed.MethodsNinety‐two N2/3 hypopharyngeal carcinoma patients were retrospectively studied. According to response after induction chemotherapy (ICT), patients were treated with neck dissection followed by concurrent CRT (CCRT) (group 1), surgery plus postoperative CRT (group 2), or CCRT for primary and regional sites (group 3).ResultsOverall survival and disease‐free survival rates of group 1 were significantly higher than group 2 (p = 0.038, p = 0.031) and group 3 (both p = 0.018). Regional control rate of group 1 was significantly higher than group 3 (p = 0.041). There were no significant differences between groups 1 and 2 regarding local and regional control (p = 0.746, p = 0.302).ConclusionsNeck dissection followed by CCRT is the best choice for patients with responsive primary but nonresponsive nodes.

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Neck management in head and neck squamous cell carcinomas: where do we stand?

Cited by 15 publications

References 100 publications

Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck

Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck

Locoregional control, progression‐free survival and morbidity rates in N3 head and neck cancer patients with low primary tumour burden: A 301‐patient study

The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma

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