Selective neck dissection in the management of the neck after (chemo)radiotherapy for advanced head and neck cancer. Proposal for a classification update

Abstract

For patients with advanced regional disease, neck dissection following (chemo)radiotherapy remains controversial. Selective neck dissection (SND) was reported as suitable after chemoradiation in patients with advanced regional disease. Reduced morbidity represents the major advantage of SND. In a situation in which there is a major fibrosis around the previously invaded nodes, resection of 1 or more nonlymphatic structures may be required. The current classification of SND could be implemented by the addition of extended selective neck dissection (ESND). The standard basic procedures for SND spare the sternocleidomastoid muscle (SCM), the internal jugular vein (IJV), and the spinal accessory nerve (SAN). When an SND is associated with the resection of 1 or more nonlymphatic structures, it should be termed ESND. All additional nonlymphatic structure(s) removed should be identified in parentheses. The proposal to subclassify SND not only in accord with the resected lymph node levels but also upon the nonlymphatic structures removed may be of some help to avoid potential misinterpretation.

Oncologic outcomes of selective neck dissection in HPV‐related oropharyngeal squamous cell carcinoma

“…In addition to advanced nodal disease, few studies of SND in the therapeutic setting examine the oncologic safety of an extended SND, including removal of nonlymphatic structures, and none examine the frequency in HPV‐related OPSCC. The concept of an extended SND has been incorporated into previous classification systems . Data regarding this technique is limited, however, and its use remains controversial .…”

Predictors of mucositis in oropharyngeal and oral cavity cancer in patients treated with volumetric modulated radiation treatment: A dose–volume analysis

“…A total dose of 60 Gy and 54 Gy in 30 fractions to PTV1 and PTV2, respectively, were prescribed using simultaneous integrated boost. Based on T and N classifications, neck nodal levels were electively irradiated according to international consensus guidelines . The dose was prescribed to cover 95% of the PTV.…”

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

“…Patients presenting with advanced local neck metastases would undergo planned ND 4–12 weeks after receiving primary RT or CRT. Traditionally, large comprehensive resections, including the 5 levels of lymph nodes with or without the sternocleidomastoid muscle, the internal jugular vein and the spinal accessory muscle, were favoured [43]. …”

“…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,…”