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

Denaro, Nerina; Russi, Elvio; Numico, Gianmauro; Pazzaia, T; Vitiello, Raffaele; Merlano, Marco

doi:10.1159/000346132

Cited by 9 publications

(8 citation statements)

References 126 publications

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“…Regardless, the results of upfront CRT, even if there is no evidence of lymph node metastases, when the risk for positive neck lymph nodes exceeds 15-20%, may indicate elective ND. In N2-3 stage with suspected viable tumour the question is about the timing and the extension of ND rather than the need of ND [54]. …”

Section: Neck Dissectionmentioning

confidence: 99%

“…Since the problem is to avoid overtreatment for those patients already cured, there are no doubts for N0-1 patients because neck control is to be expected after CRT, and also for patients with residual masses for whom ND is mandatory. For those with bulky disease even after a clinical and radiological complete response, ND will diminish the regional recurrence rate by about 15% [54]. …”

Section: Neck Dissectionmentioning

confidence: 99%

See 1 more Smart Citation

State-of-the-Art and Emerging Treatment Options in the Management of Head and Neck Cancer: News from 2013

Denaro¹,

Russi

Adamo

et al. 2014

Oncology

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Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cause of cancer death worldwide. Its treatment is complex and evolving. In general, early-stage disease may be managed with single-modality treatment while an advanced stage (about 60% of clinical presentation) needs a multidisciplinary approach. In this setting concurrent chemoradiation has been associated with improvement in locoregional control and organ preservation, but at the cost of significant acute and chronic toxicity. Molecular target therapies specially directed to epidermal growth factor receptor (EGFR) might improve the outcomes and reduce toxicities. In recurrent-metastatic (R/M) HNSCC, cetuximab, a monoclonal antibody against EGFR, plus platinum-based chemotherapy (CT) allow an overall survival (OS) of about 10 months. However, the prognosis for R/M-HNSCC remains dismal and additional efforts are needed. At the 2013 American Society of Clinical Oncology (ASCO) Meeting, data on induction CT, anti-EGFR inhibitors, innovative molecular targets and predictor factors were reported. Further results on target therapies were presented at the European Cancer Congress (ECC) 2013, where a large study also showed that hyperfractionated radiotherapy (RT) improve OS rates compared with standard RT. The aim of this review is to discuss current standards and emerging therapies by considering recent new updates.

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Section: Neck Dissectionmentioning

confidence: 99%

Section: Neck Dissectionmentioning

confidence: 99%

State-of-the-Art and Emerging Treatment Options in the Management of Head and Neck Cancer: News from 2013

Denaro¹,

Russi

Adamo

et al. 2014

Oncology

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“…The current standard of care includes surgical resection of the tumor followed by chemotherapy and radiation1. Although advances in technology have allowed for improved targeting of radiation to the tumor, salivary glands still receive significant levels of radiation throughout the course of treatment2.…”

mentioning

confidence: 99%

Autophagy Correlates with Maintenance of Salivary Gland Function Following Radiation

Morgan‐Bathke

Hill

Harris

et al. 2014

Sci Rep

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The current standard of care for head and neck cancer includes surgical resection of the tumor followed by targeted head and neck radiation. This radiotherapy results in a multitude of negative side effects in adjacent normal tissues. Autophagy is a cellular mechanism that could be targeted to ameliorate these side effects based on its role in cellular homeostasis. In this study, we utilized Atg5f/f;Aqp5-Cre mice which harbor a conditional knockout of Atg5, in salivary acinar cells. These autophagy-deficient mice display increased radiosensitivity. Treatment of wild-type mice with radiation did not robustly induce autophagy following radiotherapy, however, using a model of preserved salivary gland function by IGF-1-treatment prior to irradiation, we demonstrate increased autophagosome formation 6–8 hours following radiation. Additionally, administration of IGF-1 to Atg5f/f;Aqp5-Cre mice did not preserve physiological function. Thus, autophagy appears to play a beneficial role in salivary glands following radiation and pharmacological induction of autophagy could alleviate the negative side effects associated with therapy for head and neck cancer.

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“…In an era where the role of planned neck dissection after CRT for locoregionally advanced head and neck cancer is diminishing [ 8 – 10 ], using prognostic information derived from the clinic and radiological examinations which can help predict treatment outcome and thereby the necessity of neck dissection, is gaining importance. The goal of this study is to situate the prognostic value of the location of pathological lymph nodes, as well as size change of pathological lymph nodes as evaluated on CT studies in the follow up after (C)RT.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of location and size change of pathological lymph nodes evaluated on CT-scan following radiotherapy in head and neck cancer

et al. 2017

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BackgroundOverall survival after chemo-radiotherapy (CRT) for head and neck cancer ranges between 50 and 60% after 5 year of follow-up. Local and/or regional recurrence is the most frequent form of therapy failure. The aim of this study is to investigate whether the initial location and size change of pathological lymph nodes as evaluated on Computed Tomography (CT) studies can help predict outcome.MethodsOne hundred eighty-three patients with lymph node-positive head and neck cancer were treated with radiotherapy (RT) or CRT. CT studies pre- and post-treatment were reviewed for lymph node size and location. Data were correlated with local control, regional control, metastasis free survival, disease free survival and overall survival.ResultsRegarding the risk for distant metastasis, a significant influence was seen for the location of the pathological lymph nodes. The metastatic risk increases when levels IV-V are affected rather than levels I-III. A similar observation is seen for levels VI-VII. Regional control improves with decreasing lymph node diameter and volume as evaluated on CT.ConclusionsBoth location and size change of pathological lymph nodes are of prognostic value after CRT for head and neck cancer.

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

Cited by 9 publications

References 126 publications

State-of-the-Art and Emerging Treatment Options in the Management of Head and Neck Cancer: News from 2013

State-of-the-Art and Emerging Treatment Options in the Management of Head and Neck Cancer: News from 2013

Autophagy Correlates with Maintenance of Salivary Gland Function Following Radiation

The prognostic value of location and size change of pathological lymph nodes evaluated on CT-scan following radiotherapy in head and neck cancer

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