title: Outcomes in Advanced Head and Neck Cancer Treated with Up-front Neck Dissection prior to (Chemo)Radiotherapy.
abstract: OBJECTIVE
  Our aim was to compare outcomes with and without up-front neck dissection prior to (chemo)radiotherapy in head and neck squamous cell carcinoma.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Outcomes of oropharyngeal, laryngeal, and hypopharyngeal squamous cell carcinoma cases with neck lymph node metastases treated from January 2001 to March 2012 were analyzed. Due to imbalances in baseline characteristics between groups treated with (n = 129) and without (n = 95) up-front neck dissection, propensity score matching was performed.
  
  
  RESULTS
  Median follow-up was 48 months (range, 12-148). With up-front neck dissection, the hazard ratio for the primary end point, disease-free survival, was 0.63 (95% confidence interval: 0.37-1.06, P = .08). Up-front neck dissection reduced acute grade ≥3 toxicity significantly when xerostomia was excluded (odds ratio: 0.40, 95% confidence interval: 0.20-0.82, P = .012).
  
  
  CONCLUSIONS
  Our results indicate less acute treatment toxicity without any significant difference in terms of oncologic outcome with up-front neck dissection prior to (chemo)radiotherapy as compared with (chemo)radiotherapy alone. Well-designed randomized trials are required to verify this result and further investigate the impact of this strategy on late toxicity and oncologic outcome.
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Olgun
authors.initials: O
authors.lastname: Elicin
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Albrecht
authors.affiliation: Clinical Trials Unit Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Haynes
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Bojaxhiu
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland Department of Clinical Research, University of Bern, Bern, Switzerland.
authors.forename: Lluís
authors.initials: L
authors.lastname: Nisa
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Caversaccio
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Alan
authors.initials: A
authors.lastname: Dal Pra
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Schmücking
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Aebersold
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland roland.giger@insel.ch.
authors.forename: Roland
authors.initials: R
authors.lastname: Giger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: head and neck squamous cell carcinoma; neck dissection; radiotherapy; toxicity; up-front