Retrospective study of selective neck dissection versus radical neck dissection as salvage therapy for patients with recurrent nasopharyngeal squamous cell carcinoma

The most important prognostic factor in oral squamous cell carcinoma (OSCC) is neck metastasis, which is treated by neck dissection. Although selective neck dissection (SND) is a useful tool for clinically node-negative OSCC, its efficacy for neck node-positive OSCC has not been established. Sixty-eight OSCC patients with pN1–3 disease who were treated with curative surgery using SND and/or modified-radical/radical neck dissection (MRND/RND) were retrospectively reviewed. The neck control rate was 94% for pN1–3 patients who underwent SND. The five-year overall survival (OS) and disease-specific survival (DSS) in pN1-3 OSCC patients were 62% and 71%, respectively. The multivariate analysis of clinical and pathological variables identified the number of positive nodes as an independent predictor of SND outcome (OS, hazard ratio (HR) = 4.98, 95% confidence interval (CI): 1.48–16.72, p < 0.01; DSS, HR = 6.44, 95% CI: 1.76–23.50, p < 0.01). The results of this retrospective study showed that only SND for neck node-positive OSCC was appropriate for those with up to 2 lymph nodes that had a largest diameter ≤3 cm without extranodal extension (ENE) of the neck and adjuvant radiotherapy. However, the availability of postoperative therapeutic options for high-risk OSCC, including ENE and/or multiple positive lymph nodes, needs to be further investigated.

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Selective Neck Dissection of Anatomically Appropriate Levels Is as Efficacious as Modified Radical Neck Dissection for Elective Treatment of the Clinically Negative Neck in Patients With Squamous Cell Carcinoma of the Upper Respiratory and Digestive Tracts

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.124.3.348 ◽

1998 ◽

Vol 124 (3) ◽

pp. 348 ◽

Cited By ~ 73

Author(s):

Gary L. Clayman ◽

Douglas K. Frank

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Radical Neck Dissection ◽

Selective Neck Dissection ◽

Modified Radical Neck Dissection ◽

Elective Treatment ◽

Upper Respiratory

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Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000200009 ◽

2008 ◽

Vol 126 (2) ◽

pp. 112-118 ◽

Cited By ~ 4

Author(s):

Jamile Karina Antonio ◽

Marcelo Benedito Menezes ◽

Norberto Kodi Kavabata ◽

Antonio Augusto Tupinambá Bertelli ◽

William Kikuchi ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Radical Neck Dissection ◽

Aerodigestive Tract ◽

Selective Neck Dissection ◽

Upper Aerodigestive Tract ◽

Disease Evolution ◽

Node Positive

CONTEXT AND OBJECTIVE: Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. DESIGN AND SETTING: Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). METHODS: We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). RESULTS: Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. CONCLUSIONS: SND may be a good option for treating node-positive necks in selected cases.

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