Outcome With Neck Dissection After Chemoradiation for N3 Head-and-Neck Squamous Cell Carcinoma

Igidbashian, Levon; Fortin, B.; Guertin, Louis; Soulières, Denis; Coulombe, Geneviève; Bélair, Manon; Charpentier, Danielle; Tabet, Jean‐Claude; Nguyen-Tân, Phuc Félix

doi:10.1016/j.ijrobp.2009.05.034

Cited by 34 publications

(33 citation statements)

References 60 publications

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“…However, N3 disease is infrequent and there have been few reports on the role of initial ND for patients with N3 head and neck cancer. Igidbashian et al reported the outcome of 70 patients with N3 disease treated by CRT with or without ND [13]. They found that the disease-free survival rate of patients with ND was higher than that of patients without ND.…”

Section: Discussionmentioning

confidence: 99%

The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas

et al. 2014

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Section: Discussionmentioning

confidence: 99%

The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas

et al. 2014

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“…The advantage of ND in N3 disease was also confirmed in a population of 90 patients treated with definitive intensity modulated RT; regardless of the initial staging the partial responders systematically underwent ND while the complete responders did not, and those who underwent ND had better outcomes than other patients [27]. Results from studies on patients treated with CRT who underwent ND are reported in table 1.…”

Section: The Risk Benefit Ratio Of Ndmentioning

confidence: 92%

“…Moreover, the use of intensity modulated RT providing high-dose conformal RT improves local region control compared to standard RT so that it is no longer clear if an invasive procedure is still requested [8,9,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]. …”

Section: The Risk Benefit Ratio Of Ndmentioning

confidence: 99%

“…On the one hand is the risk of neck recurrences or microscopic residual disease, on the other hand is the probability of an overtreatment with possible surgical complications (lymphedema, dysphagia, fistulae) [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72]. Benefits may include local regional control and OS [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,…”

Section: Introduction: Pros and Consmentioning

confidence: 99%

“…There is an interval of weeks when a useful immediate ND may be performed in order to reduce surgical complications considered by the majority of authors more useful than a salvage delayed ND [2,6,14,15,24,25,26,27,28,29,30]. …”

Section: Introduction: Pros and Consmentioning

confidence: 99%

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The Role of Neck Dissection after Radical Chemoradiation for Locally Advanced Head and Neck Cancer: Should We Move Back?

Denaro

Russi²,

Numico³

et al. 2013

Oncology

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Until a few decades ago neck dissection (ND) was the standard surgical approach for node-positive tumours. Nowadays patients with locally advanced head and neck cancer can be treated with definitive chemoradiation (CRT), which includes the treatment of the neck; however, results on residual viable tumour after conservative treatment are heterogeneous and depend on initial node stage and primary treatment. Many authors accept adjuvant surgery in patients with N2–3 disease. Regardless of the results of upfront CRT, even if there is no evidence of lymph node metastases, when the risk for persistent positive neck nodes exceeds 15–20%, elective ND might be indicated. However, despite the diffusion of innovative technologies and therapies, there are controversies about both response evaluation and surgical management of initially involved neck nodes after definitive CRT and organ preservation treatment. In this paper we will analyse state of art of neck evaluation after CRT and discuss the role of ND.

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Retrospective Review of Positron Emission Tomography With Contrast-Enhanced Computed Tomography in the Posttreatment Setting in Human Papillomavirus–Associated Oropharyngeal Carcinoma

Chan¹,

Sanguineti²,

Richmon³

et al. 2012

Arch Otolaryngol Head Neck Surg

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Objective To determine the value of positron emission tomography (PET) with contrast-enhanced computed tomography (CT) in assessing the need for neck dissection by retrospectively reviewing the pathology reports of patients with human papillomavirus (HPV)- associated oropharyngeal squamous cell carcinoma (SCC). Design Retrospective cohort study. Setting Tertiary medical center. Patients Seventy-seven patients with HPV-related SCC. Main Outcome Measures Seventy-seven consecutive patients with a diagnosis of HPV-related SCC who were treated with radiotherapy as the primary treatment between August 2007 and October 2010 were retrospectively evaluated for radiologic and pathologic rate of persistence of nodal metastasis after completion of definitive radiotherapy. Pretreatment and posttreatment imaging included contrast-enhanced CT and PET. Response to treatment was measured on CT, PET at standardized uptake value (SUV) thresholds of 2 and 2.5, and PET/CT by a neuroradiologist in a blinded fashion. Then, the pathology report of the patients who underwent neck dissections was reviewed for nodal status after resection and correlated with the imaging findings. Results Of the 77 patients, 67 met the study criteria, with an average follow-up PET/CT scan at 90.5 days after completion of radiotherapy. Ten patients did not undergo follow-up PET/CT imaging. Twenty patients underwent neck dissections after completion of radiation therapy. Of these 20 patients, 4 had persistent tumor and 16 did not have viable tumor. Using the final pathology report to correlate with imaging responses, CT had a negative predictive value (NPV) of 85.7% (95% CI, 48.7%-97.4%), PET with SUV thresholds of 2 had an NPV of 91.7% (95% CI, 64.6%-98.5%), PET with a cutoff SUV of 2.5 had an NPV of 85.7% (95% CI, 60.1%-96.0%), PET/CT with an SUV of 2 had an NPV of 100% (95% CI, 59.8%-100.0%), and PET/CT with an SUV of 2.5 had an NPV of 85.7% (95% CI, 48.7%-97.4%). The 47 patients who did not undergo neck dissection had a median follow-up of 26 months without an isolated neck failure. Analysis of all 67 patients in the cohort revealed the following values: CT had an NPV of 95.7% (95% CI, 85.8%-98.8%), PET with an SUV of 2 had an NPV of 98.2% (95% CI, 90.4%-99.7%), PET with an SUV of 2.5 had an NPV of 95.0% (95% CI, 86.3%-98.3%), PET/CT with an SUV of 2 had an NPV of 100.0% (95% CI, 92.0%-100.0%), and PET/CT with an SUV of 2.5 had an NPV of 95.7% (95% CI, 85.8%-98.8%). Conclusions Positron emission tomography combined with contrast-enhanced CT has a better NPV than either imaging modality alone in patients with HPV-associated oropharyngeal SCC. Furthermore, PET/CT with an SUV threshold of 2 used in patients with HPV-related SCC offers an imaging modality with a high NPV that may obviate the need for unnecessary neck dissections.

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Outcome With Neck Dissection After Chemoradiation for N3 Head-and-Neck Squamous Cell Carcinoma

Cited by 34 publications

References 60 publications

The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas

The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas

The Role of Neck Dissection after Radical Chemoradiation for Locally Advanced Head and Neck Cancer: Should We Move Back?

Retrospective Review of Positron Emission Tomography With Contrast-Enhanced Computed Tomography in the Posttreatment Setting in Human Papillomavirus–Associated Oropharyngeal Carcinoma

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