title: Management of the neck in the setting of definitive chemoradiation: is there a consensus? A GETTEC study.
abstract: BACKGROUND
  The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease
  
  
  METHODS
  We studied the patterns of care in the French-Belgian Groupe d'Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey.
  
  
  RESULTS
  Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND.
  
  
  CONCLUSIONS
  Omission of ND based on computed tomographic scan and positron emission tomography-based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus-related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.
authors.affiliation: Department of Radiotherapy, Center Antoine-Lacassagne, IUFC, Nice, France. jthariat@hotmail.com
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.forename: Marc
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authors.lastname: Hamoir
authors.forename: Renaud
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authors.lastname: Garrel
authors.forename: Alain
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authors.lastname: Malard
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authors.lastname: Benlyazid
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authors.initials: RJ
authors.lastname: Bensadoun
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authors.lastname: Merol
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authors.lastname: Scavennec
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authors.lastname: Salvan
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authors.lastname: Mallet
authors.forename: S
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authors.lastname: Moriniere
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authors.lastname: Vergez
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authors.lastname: Choussy
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authors.lastname: Dollivet
authors.forename: N
authors.initials: N
authors.lastname: Guevara
authors.forename: P
authors.initials: P
authors.lastname: Ceruse
authors.forename: D
authors.initials: D
authors.lastname: De Raucourt
authors.forename: B
authors.initials: B
authors.lastname: Lallemant
authors.forename: G
authors.initials: G
authors.lastname: Lawson
authors.forename: P
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authors.lastname: Lindas
authors.forename: M
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authors.lastname: Poupart
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authors.lastname: Duflo
authors.forename: Xavier
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authors.lastname: Dufour
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D032921:Consensus; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy; D037981:Neck Dissection; D049268:Positron-Emission Tomography; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011379:Prognosis; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed