Stage I-II squamous cell carcinoma of the oral cavity treated by iridium-192: is elective neck dissection indicated?
This is a retrospective analysis of 233 evaluable patients with stage I-II squamous cell carcinoma of the oral cavity treated by definitive branchytherapy. Minimum follow-up is 3 years. Treatment of neck was chosen by a multidisciplinary team, according to age, medical status and availability for regular follow-up. One hundred and ten patients (47%) underwent elective neck dissection (END); 28 (25%) had positive nodes and received neck irradiation post-operatively. One hundred and twenty three patients (53%) were regularly followed up only, with therapeutic neck dissection (TND) reserved for cases of node relapses. In the END group, there were 19 neck relapses (17%): 12/60 (20%) in patients with mobile tongue carcinoma and 7/50 (14%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 9/19 (47%) cases. In the TND group, there were 21 neck relapses (17%): 16/82 (20%) in patients with mobile tongue carcinoma and 5/41 (10%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 13/21 (62%) cases. Ten-year survival is 37% for the END group and 31% for the TND group. Tumour stage and infiltration into underlying tissues increased the probability of neck relapse and death. Furthermore, a multivariate analysis showed that patients treated in the TND group had a higher probability of death than patients treated in the END group (p less than 0.04).
Piedbois
P
P
Département de Cancérologie, Hôpital Henri Mondor, Créteil, France.
Mazeron
J J
JJ
Haddad
E
E
Coste
A
A
Martin
M
M
Levy
C
C
Raynal
M
M
Pavlovitch
J M
JM
Peynegre
R
R
Pierquin
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D000075202:Contraindications; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008198:Lymph Nodes / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009333:Neck / Q000528:radiation effects; D037981:Neck Dissection; D009367:Neoplasm Staging
D007496:Iridium Radioisotopes