Elective versus therapeutic neck dissection in the clinically node negative neck in early oral cavity cancers: Do we have the answer yet?

Aim. To share experience with regional failures after selective neck dissection in both node negative and positive previously untreated patients diagnosed with squamous cell carcinoma of the oral cavity.Patients and Methods. Data of 219 patients who underwent SND at Shaukat Khanum Cancer Hospital from 2003 to 2010 were retrospectively reviewed. Patient characteristics, treatment modalities, and regional failures were assessed. Expected 5-year regional control was calculated and prognostic factors were determined.Results. Median follow-up was 29 (9–109) months. Common sites were anterior tongue in 159 and buccal mucosa in 22 patients. Pathological nodal stage was N0 in 114, N1 in 32, N2b in 67, and N2c in 5 patients. Fourteen (6%) patients failed in clinically node negative neck while 8 (4%) failed in clinically node positive patients. Out of 22 total regional failures, primary tumor origin was from tongue in 16 (73%) patients. Expected 5-year regional control was 95% and 81% for N0 and N+ disease, respectively (P<0.0001). Only 13% patients with well differentiated, T1 tumors in cN0 neck were pathologically node positive.Conclusions. Selective neck dissection yields acceptable results for regional management of oral squamous cell carcinoma. Wait and see policy may be effective in a selected subgroup of patients.

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Late nodal metastasis in early-stage node-negative oral cavity cancers after successful sole interstitial brachytherapy: An institutional experience of 42 cases in India

Brachytherapy ◽

10.1016/j.brachy.2009.11.001 ◽

2010 ◽

Vol 9 (3) ◽

pp. 254-259 ◽

Cited By ~ 6

Author(s):

Bikramjit Chakrabarti ◽

Suman Ghorai ◽

Bishan Basu ◽

Sajal Kumar Ghosh ◽

Phalguni Gupta ◽

...

Keyword(s):

Oral Cavity ◽

Early Stage ◽

Nodal Metastasis ◽

Interstitial Brachytherapy ◽

Node Negative ◽

Institutional Experience ◽

Oral Cavity Cancers

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The relationship between primary tumour thicknesses in cancers of the oral cavity to subsequent lymph node metastasis

International Surgery Journal ◽

10.18203/2349-2902.isj20173727 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2957

Author(s):

Ahmed Fawzy ◽

Waleed Ali Al zaqri ◽

Mohamed Sabry ◽

Ahmed Sabry ◽

Hosam El Fol ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Oral Cavity ◽

Neck Dissection ◽

Tumor Thickness ◽

Elective Neck Dissection ◽

Pathological State ◽

Cervical Lymph Nodes ◽

Node Metastasis ◽

Oral Cavity Cancers

Background: Elective dissection of cervical lymph nodes in oral cavity cancers gives very precious data on its pathological state, judge for adjuvant therapy requirement plus its therapeutic effect but it has its morbidities that cannot be condoned. Tumor thickness (TT) in oral cavity cancers show an increasing value to be one of the most important and reliable factors that have a great relationship to regional node involvement.Methods: Forty-three patients with T1, T2 oral cavity squamous cell carcinoma with clinically and radiologically negative cervical L.Ns underwent elective neck dissection and the relation between the tumor thickness and the nodal metastasis was monitored. Tumor thickness was estimated preoperatively by using the intra-oral ultrasound and confirmed by histopathology postoperatively.Results: Only 12 out of 43 neck dissections (27.9%) showed positive L.Ns metastasis of primary tumor. The excised number of L.Ns ranged from 15 to 31 with mean±SD (21.58±3.59) L.Ns. The (TT) ranged from 1.4 mm to 7.8 mm. Our statistical results showed that there is a cutoff point which was 4 mm where (TT) > 4 mm showed significant results with histologically found positive cervical node metastasis compared to (TT) ≤4 mm specimens.Conclusions: Relationship of tumor thickness to lymph node metastasis was found to be significant as shown by this study. Our results clearly demonstrate that conservative elective neck dissection is indicated in patients with stage I/II oral cavity carcinoma whose tumors are > 4 mm in thickness as they mostly have latent metastasis.

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Supraomohyoid neck dissection with frozen section biopsy as a staging procedure in the clinically node-negative neck in carcinoma of the oral cavity

The American Journal of Surgery ◽

10.1016/0002-9610(91)90151-3 ◽

1991 ◽

Vol 162 (4) ◽

pp. 373-376 ◽

Cited By ~ 32

Author(s):

Johannes J. Manni ◽

Frank J.A. van den Hoogen

Keyword(s):

Oral Cavity ◽

Neck Dissection ◽

Frozen Section ◽

Node Negative ◽

Supraomohyoid Neck Dissection

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Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity

World Journal of Surgical Oncology ◽

10.1186/s12957-018-1518-z ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 8

Author(s):

Manoj Pandey ◽

Senniappan Karthikeyan ◽

Deepika Joshi ◽

Mohan Kumar ◽

Mridula Shukla

Keyword(s):

Randomized Controlled Trial ◽

Oral Cavity ◽

Neck Dissection ◽

Controlled Trial ◽

Squamous Carcinoma ◽

Node Negative ◽

Randomized Controlled

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Cost-Effectiveness Analysis of Elective Neck Dissection in Patients With Clinically Node-Negative Oral Cavity Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.4563 ◽

2016 ◽

Vol 34 (32) ◽

pp. 3886-3891 ◽

Cited By ~ 15

Author(s):

Joseph R. Acevedo ◽

Katherine E. Fero ◽

Bayard Wilson ◽

Assuntina G. Sacco ◽

Loren K. Mell ◽

...

Keyword(s):

Cost Effectiveness ◽

Oral Cavity ◽

Neck Dissection ◽

Oral Cavity Cancer ◽

Early Stage ◽

Cost Effective ◽

Disease Recurrence ◽

Elective Neck Dissection ◽

Node Negative ◽

Primary Surgery

Purpose Recently, a large randomized trial found a survival advantage among patients who received elective neck dissection in conjunction with primary surgery for clinically node-negative oral cavity cancer compared with those receiving primary surgery alone. However, elective neck dissection comes with greater upfront cost and patient morbidity. We present a cost-effectiveness analysis of elective neck dissection for the initial surgical management of early-stage oral cavity cancer. Methods We constructed a Markov model to simulate primary, adjuvant, and salvage therapy; disease recurrence; and survival in patients with T1/T2 clinically node-negative oral cavity squamous cell carcinoma. Transition probabilities were derived from clinical trial data; costs (in 2015 US dollars) and health utilities were estimated from the literature. Incremental cost-effectiveness ratios, expressed as dollar per quality-adjusted life-year (QALY), were calculated with incremental cost-effectiveness ratios less than $100,000/QALY considered cost effective. We conducted one-way and probabilistic sensitivity analyses to examine model uncertainty. Results Our base-case model found that over a lifetime the addition of elective neck dissection to primary surgery reduced overall costs by $6,000 and improved effectiveness by 0.42 QALYs compared with primary surgery alone. The decrease in overall cost despite the added neck dissection was a result of less use of salvage therapy. On one-way sensitivity analysis, the model was most sensitive to assumptions about disease recurrence, survival, and the health utility reduction from a neck dissection. Probabilistic sensitivity analysis found that treatment with elective neck dissection was cost effective 76% of the time at a willingness-to-pay threshold of $100,000/QALY. Conclusion Our study found that the addition of elective neck dissection reduces costs and improves health outcomes, making this a cost-effective treatment strategy for patients with early-stage oral cavity cancer.

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