title: The role of neck dissection in the setting of chemoradiation therapy for head and neck squamous cell carcinoma with advanced neck disease.
abstract: Concurrent chemotherapy and radiotherapy (CRT) has become standard treatment for many patients with advanced head and neck squamous cell carcinoma (HNSCC). This has led to controversy concerning the role of neck dissection (ND) in this setting. The current debate is focused on N2-N3 disease and the ability of a clinical complete response to predict the absence of viable cells in the ND specimen. Proponents of a systematic planned ND argue that it improves regional control and possibly disease-specific survival. They assert that a clinical response does not predict the pathologic response, and that in the event of recurrence in the neck, a surgical salvage procedure is unlikely to succeed. Conversely, there are many arguments in favor of performing ND only for patients who have evidence of residual neck disease because of the very low probability of isolated neck recurrence following a complete response. Proponents argue that for complete responders, planned ND is associated with no survival benefit. As planned surgery will only benefit patients with residual disease in the neck alone, there is a high rate of unnecessary ND with its associated morbidity. Another question concerns the appropriate type of ND to be performed. Even if required after chemoradiation, selective ND is oncologically feasible with minimal morbidity. Lastly, robust data from a randomized trial demonstrating the superiority of one approach vs. the other are lacking. After conducting a review of recent literature on the subject, the authors conclude that planned ND is not necessary for patients with complete response because of the availability of improved diagnostic follow up modalities, and the increased sensitivity to CRT of HNSCC, particularly HPV associated tumors.
authors: Department of Head and Neck Surgery, St. Luc University Hospital and Cancer Center, Brussels, Belgium.
authors: Marc
authors: M
authors: Hamoir
authors: Alfio
authors: A
authors: Ferlito
authors: Sandra
authors: S
authors: Schmitz
authors: François-Xavier
authors: FX
authors: Hanin
authors: Juliette
authors: J
authors: Thariat
authors: Birgit
authors: B
authors: Weynand
authors: Jean-Pascal
authors: JP
authors: Machiels
authors: Vincent
authors: V
authors: Grégoire
authors: K Thomas
authors: KT
authors: Robbins
authors: Carl E
authors: CE
authors: Silver
authors: Primož
authors: P
authors: Strojan
authors: Alessandra
authors: A
authors: Rinaldo
authors: June
authors: J
authors: Corry
authors: Robert P
authors: RP
authors: Takes
mesh_terms: D044963:Biopsy, Fine-Needle; D002294:Carcinoma, Squamous Cell / Q000601:surgery* / Q000628:therapy; D059248:Chemoradiotherapy; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18