Outcome after elective neck dissection and observation for the treatment of the clinically node-negative neck (cN0) in squamous cell carcinoma of the oropharynx

Abstract

Optimal elective neck treatment in node-negative (cN0) oropharyngeal squamous cell carcinoma (OPSCC) patients is still controversially discussed. Retrospective chart review of 49 cT1-3 cN0 cM0 OPSCC patients, who had undergone surgical resection of the primary and either elective neck dissection (END) (n = 32) or observation (OBS) (n = 17) of the neck was performed. For systematic review of literature, Pubmed and EMBASE were searched for clinical studies including data on both END and OBS of the neck in cN0 OPSCC patients. Estimated 5-year overall survival (OS) rate was 82 % for END and 76 % for OBS [hazard ratio (HR) = 1.01]. Estimated 5-year disease-free survival (DFS) rate was 78 % for END and 67 % for OBS (HR = 1.79); 5-year DSS rate was 97 % (END) and 81 % (OBS) (HR = 2.22). None of the primary outcome variables (OS, DFS, DSS) revealed statistically significant effects for the treatment assignments. Hazard ratios implied an advantage for END. Systematic review of literature yielded only retrospective chart reviews and no data meeting our selection criteria for further data analysis. Due to lack of high-level evidence, the decision for END in cN0 OPSCC remains a diagnostic and therapeutic challenge. The demonstrated clinical equipoise would provide a solid basis for a multicentric, randomized trial.

Tumoral Expression of CD 44 and HIF 1α Predict Stage I Oral Cavity Squamous Cell Carcinoma Outcome

“…This reflects an effective follow‐up protocol and active secondary treatment when any recurrences are detected. This is also consistent with the studies showing no survival advantage for END patients in comparison to watchful waiting in clinically N0 neck in T1‐2 head and neck cancer …”

Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline

“…159 Patients undergoing surgery as the definitive treatment modality should receive neck dissection. In a meta-analysis of clinical studies, 65 patients who received END had an estimated 5year disease-specific survival rate of 97% versus 81% in patients who were observed (hazard ratio, 2.22).…”

Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma

“…However, the efficacy of elective neck treatment in clinically N0 oropharyngeal cancer has not yet been demonstrated with prospective studies, and observation is used as an option in some centers. In a series of 49 patients with clinically N0 oropharyngeal cancer, neck recurrence rates were 10% and 24% for the elective neck dissection and observation groups, respectively . However, only 50% of the patients with recurrences in the observation group could be successfully salvaged.…”