title: Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.
abstract: This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. A rational plan to manage the neck is necessary for all head and neck primaries. With the emergence of new level 1 evidence across several domains of neck metastases, this guideline will identify the evidence-based recommendations for management. Recommendations • Computed tomographic or magnetic resonance imaging is mandatory for staging neck disease, with choice of modality dependant on imaging modality used for the primary site, local availability and expertise. (R) • Patients with a clinically N0 neck, with more than 15-20 per cent risk of occult nodal metastases, should be offered prophylactic treatment of the neck. (R) • The treatment choice of for the N0 and N+ neck should be guided by the treatment to the primary site. (G) • If observation is planned for the N0 neck, this should be supplemented by regular ultrasonograms to ensure early detection. (R) • All patients with T1 and T2 oral cavity cancer and N0 neck should receive prophylactic neck treatment. (R) • Selective neck dissection (SND) is as effective as modified radical neck dissection for controlling regional disease in N0 necks for all primary sites. (R) • SND alone is adequate treatment for pN1 neck disease without adverse histological features. (R) • Post-operative radiation for adverse histologic features following SND confers control rates comparable with more extensive procedures. (R) • Adjuvant radiation following surgery for patients with adverse histological features improves regional control rates. (R) • Post-operative chemoradiation improves regional control in patients with extracapsular spread and/or microscopically involved surgical margins. (R) • Following chemoradiation therapy, complete responders who do not show evidence of active disease on co-registered positron emission tomography-computed tomography (PET-CT) scans performed at 10-12 weeks, do not need salvage neck dissection. (R) • Salvage surgery should be considered for those with incomplete or equivocal response of nodal disease on PET-CT. (R).
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Institute of Cancer Research,Newcastle upon Tyne,UK.
authors.forename: V
authors.initials: V
authors.lastname: Paleri
authors.affiliation: Department of Oncology,Guy's and St Thomas' Hospitals,London,UK.
authors.forename: T G
authors.initials: TG
authors.lastname: Urbano
authors.affiliation: Institute of Head and Neck Studies and Education, University of Birmingham, University Hospital,Birmingham,UK.
authors.forename: H
authors.initials: H
authors.lastname: Mehanna
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery,Queen Alexandra Hospital,Portsmouth,UK.
authors.forename: C
authors.initials: C
authors.lastname: Repanos
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery,University Hospital Aintree,Liverpool,UK.
authors.forename: J
authors.initials: J
authors.lastname: Lancaster
authors.affiliation: Department of Clinical Oncology,Norfolk and Norwich University Hospital,Norwich,UK.
authors.forename: T
authors.initials: T
authors.lastname: Roques
authors.affiliation: Department of Oral and Maxillofacial Surgery,University Hospital of South Manchester NHS Foundation Trust,Manchester,UK.
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Clinical Oncology,St James's Institute of Oncology,Leeds,UK.
authors.forename: M
authors.initials: M
authors.lastname: Sen
mesh_terms: D000465:Algorithms; D059248:Chemoradiotherapy / Q000592:standards; D003131:Combined Modality Therapy / Q000592:standards; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D006801:Humans; D033183:Interdisciplinary Communication; D008279:Magnetic Resonance Imaging / Q000592:standards; D037981:Neck Dissection / Q000592:standards; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D009367:Neoplasm Staging / Q000592:standards; D010166:Palliative Care / Q000592:standards; D021701:Sentinel Lymph Node Biopsy / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000592:standards; D006113:United Kingdom