Up‐front neck dissection followed by concurrent chemoradiation in patients with regionally advanced head and neck cancer

Abstract

Background The appropriate management of the neck in patients with regionally advanced head and neck cancer remains controversial. The purpose of this study was to retrospectively analyze our institutional experience with up-front neck dissection followed by definitive chemoradiotherapy. Methods Fifty-five patients with radiographic evidence of large or necrotic lymph nodes underwent up-front neck dissection followed by definitive chemoradiation. Results The 5-year overall survival (OS) and progression-free survival (PFS) rates were estimated at 71.3% and 64.7%, respectively. There were 2 failures in the dissected neck, for a control rate of 96.7%. There were 7 locoregional failures and 12 distant failures, for locoregional and distant control rates of 87.3% and 78.2%, respectively. Conclusion Up-front neck dissection followed by chemoradiotherapy resulted in excellent locoregional control, OS, and PFS. Utilization of this strategy should be considered in carefully selected patients with regionally advanced head and neck cancer.

Up-front neck dissection followed by definitive (chemo)-radiotherapy in head and neck squamous cell carcinoma: Rationale, complications, toxicity rates, and oncological outcomes – A systematic review

“…The literature search yielded a total of 1131 articles and abstracts. Only 15 of those met all inclusion criteria and were considered for final analysis [31,[37][38][39][40][41][42][45][46][47][48][49][50][51][52]. A flowchart detailing the number of screened, included and excluded articles, as well as the reasons for exclusion is provided in Fig.…”

“…Two-dimensional conventional RT was reported in 5 studies [31,39,42,47,50]. Three-dimensional conformal and IMRT techniques were described in 3 studies [37,40,51]. Most of the study cohorts were treated in an era when the use of concomitant chemotherapy was not established as standard (published until 2001).…”

“…Post-UFND complications were reported in 13 studies. Eight of them reported total postoperative complication rates of less than 10% [31,37,38,41,42,46,50,51] whereas the remaining 5 studies showed complications between 12% and 37% [39,40,47,48,52]. Postoperative complications were assessed in 2 studies comparing strategies with and without UFND [31,42].…”

“…Six authors [31,39,41,45,49,50] did not mention toxicity and in the other 9 articles [37,38,40,42,[46][47][48]51,52] different scales or subjective evaluations were used. Percentage of ''serious" or grade P 3 toxicities ranged from 0% to 80% for acute [40,46,47,51,52] and 0-20% for late toxicities [37,38,40,42,[46][47][48]51] among cases treated with UFND strategy. Two authors compared grade P 3 toxicities among the groups treated with and without UFND: Allal et al [47] found no significant differences for acute (80% vs. 86%) and late toxicities (8% vs. 6%), whereas Al-Mamgani [51] reported significantly higher grade 3 acute toxicity in patients treated with Table 2 Description of studies with more than one arm.…”

“…The so called up-front ND (UFND) is currently less known and performed [6], but confers the advantages of avoiding adjuvant surgery on a previously irradiated neck as well as the removal of hypoxic tissues and bulky nodal metastases, which may be less responsive to (C)RT and possibly associated to an increased risk of distant metastases [34][35][36]. Satisfying control and postoperative complication rates with UFND, along with minimal delay of definitive treatment, have been reported previously [31,[37][38][39][40][41][42]. Despite the good results of UFND, many authors consider this approach as a redundant strategy, since definitive (C)RT will take place to the primary tumor site and the neck [25,43].…”