title: 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.
abstract: Lymph node metastases of head and neck cancer are considered one of the most negative prognostic factors. While outcomes and feasibility of chemo-radiotherapy ((C)RT) with or without adjuvant planned neck dissection (ND) in organ-preservation treatment strategy have been addressed, the role of ND before (C)RT, called up-front neck dissection (UFND), is not clearly established. This review provides a critical appraisal of UFND.
  
  
  
  Articles were identified with a systematic approach. Outcomes included post-UFND delay of (C)RT, surgical complications, radiation toxicity and oncologic outcome.
  
  
  
  Fifteen studies met inclusion criteria, totaling 607 patients undergoing UFND. Part of the data suggest advantages toward less surgical complications compared with salvage ND, decreased serious acute radiation toxicity and better oncological outcomes when compared with (C)RT alone. The overall heterogeneity of the analyzed data does not allow a meta-analysis that provides high-quality evidence in favor or against UFND.
  
  
  
  Due to lack of well-designed randomized trials, it is difficult to assess the role of UFND in organ-preserving (C)RT setting of head and neck cancer.
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. Electronic address: olgun.elicin@insel.ch.
authors.forename: Olgun
authors.initials: O
authors.lastname: Elicin
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Department of Otorhinolaryngology - Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Department of Clinical Research, University of Bern, Switzerland.
authors.forename: Lluís
authors.initials: L
authors.lastname: Nisa
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of 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, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Bojaxhiu
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery, Inselspital, Bern University Hospital, and University of 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, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Schmücking
authors.affiliation: Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Department of Clinical Research, University of Bern, Switzerland.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Aebersold
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Giger
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D037981:Neck Dissection; D011832:Radiation Injuries / Q000209:etiology; D012189:Retrospective Studies; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Head and neck; Neck dissection; Radiotherapy; Squamous cell carcinoma; Up-front