Planned Neck Dissection after Concomitant Radiochemotherapy for Advanced Head and Neck Cancer

Abstract

The integration of planned neck dissection into the multidisciplinary management of patients with locoregionally advanced SCCHN is highly effective in controlling cervical metastatic disease. Modified and selective neck dissection procedures can be performed in the majority of patients, regardless of the response in the neck subsequent to concomitant radiochemotherapy. We recommend a planned neck dissection(s) in all patients staged (pretreatment) with N2 or greater neck disease and in select N1 cases.

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

“…In comparison, a strategy based on combined PET/CT findings could have reduced the number of such procedures to 13 (5 TP, 8 FP) while missing 2 of the 84 heminecks (2%) or 2 of 7 heminecks eventually found to harbor residual disease. Although clinical factors, such as the initial nodal stage, are also important considerations, none of these parameters can reliably identify the subset of patients requiring surgical intervention after the end of chemoradiotherapy (5,(10)(11)(12)(13)34). Thus, a PET/CT-based strategy might reduce the element of arbitrary decision making in these patients, but this would have to be confirmed in a prospective study.…”

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

“…Other single-arm and retrospective studies have reported that planned ND demonstrated excellent locoregional control, although some did not detect improvement in overall or disease-specific survival in their series. [11][12][13][14] In addition, it has been found that in up to 40% of patients who show a complete clinical response to CRT but who undergo ND 8-10 weeks later tumour deposits can still be detected histologically in the ND specimen. 11,14,15 It has therefore been suggested that CRT does not completely eradicate the tumour in up to 40% of patients.…”

“…[11][12][13][14] In addition, it has been found that in up to 40% of patients who show a complete clinical response to CRT but who undergo ND 8-10 weeks later tumour deposits can still be detected histologically in the ND specimen. 11,14,15 It has therefore been suggested that CRT does not completely eradicate the tumour in up to 40% of patients. Furthermore, proponents of ND maintain that selecting patients at a high risk of persistent disease is not possible using CT and/or magnetic resonance imaging (MRI), as studies have found that clinical and imaging evidence of complete response (CR) of nodal disease to CRT does not predict a complete pathological response (i.e.…”

Phase I/II Study of Oncolytic HSVGM-CSF in Combination with Radiotherapy and Cisplatin in Untreated Stage III/IV Squamous Cell Cancer of the Head and Neck

“…The recommended phase II dose is 10 6 , 10 8 , 10 8 , 10 8 . Locoregional control was achieved in all patients, with a 76.5% relapse-free rate so far.…”

“…2, 3). In patients with bulky cervical nodes, CRT is often followed by neck dissection (2,(4)(5)(6)(7)(8)(9)(10)(11). Even with intensive treatment, 35% to 55% of patients develop locoregional or metastatic recurrence within two years (5,(12)(13)(14)(15).…”