scholarly journals Comment on “Nationwide randomised trial evaluating elective neck dissection for early-stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort.”

2020 ◽  
Vol 123 (7) ◽  
pp. 1198-1199 ◽  
Author(s):  
Harsh Dhar ◽  
Richa Vaish ◽  
Anil K. D’Cruz
Keyword(s):  
Oral Cancer ◽  
Neck Dissection ◽  
Real World ◽  
Early Stage ◽  
Meta Analysis ◽  
Randomised Trial ◽  
Elective Neck Dissection

scholarly journals Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort

2019 ◽  
Vol 121 (10) ◽  
pp. 827-836 ◽  
Author(s):  
Iain L. Hutchison ◽  
Fran Ridout ◽  
Sharon M. Y. Cheung ◽  
Neil Shah ◽  
Peter Hardee ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Neck Dissection ◽  
Early Stage ◽  
Meta Analysis ◽  
Randomised Trial ◽  
Research Network ◽  
Elective Neck Dissection ◽  
Risk Of Death ◽  
Neck Disease ◽  
Observational Cohort

Abstract Background Guidelines remain unclear over whether patients with early stage oral cancer without overt neck disease benefit from upfront elective neck dissection (END), particularly those with the smallest tumours. Methods We conducted a randomised trial of patients with stage T1/T2 N0 disease, who had their mouth tumour resected either with or without END. Data were also collected from a concurrent cohort of patients who had their preferred surgery. Endpoints included overall survival (OS) and disease-free survival (DFS). We conducted a meta-analysis of all six randomised trials. Results Two hundred fifty randomised and 346 observational cohort patients were studied (27 hospitals). Occult neck disease was found in 19.1% (T1) and 34.7% (T2) patients respectively. Five-year intention-to-treat hazard ratios (HR) were: OS HR = 0.71 (p = 0.18), and DFS HR = 0.66 (p = 0.04). Corresponding per-protocol results were: OS HR = 0.59 (p = 0.054), and DFS HR = 0.56 (p = 0.007). END was effective for small tumours. END patients experienced more facial/neck nerve damage; QoL was largely unaffected. The observational cohort supported the randomised findings. The meta-analysis produced HR OS 0.64 and DFS 0.54 (p < 0.001). Conclusion SEND and the cumulative evidence show that within a generalisable setting oral cancer patients who have an upfront END have a lower risk of death/recurrence, even with small tumours. Clinical Trial Registration NIHR UK Clinical Research Network database ID number: UKCRN 2069 (registered on 17/02/2006), ISCRTN number: 65018995, ClinicalTrials.gov Identifier: NCT00571883.

Sentinel node biopsy versus elective neck dissection in early-stage oral cancer: a systematic review

2020 ◽  
Vol 277 (12) ◽  
pp. 3247-3260
Author(s):  
F. M. Crocetta ◽  
C. Botti ◽  
C. Pernice ◽  
D. Murri ◽  
A. Castellucci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Oral Cancer ◽  
Sentinel Node ◽  
Neck Dissection ◽  
Sentinel Node Biopsy ◽  
Early Stage ◽  
Elective Neck Dissection ◽  
Node Biopsy

scholarly journals Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1783 ◽  
Author(s):  
Inne J. den Toom ◽  
Koos Boeve ◽  
Daphne Lobeek ◽  
Elisabeth Bloemena ◽  
Maarten L. Donswijk ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Oral Cancer ◽  
Neck Dissection ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Elective Neck Dissection ◽  
Floor Of Mouth ◽  
Node Biopsy

Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, p = 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.

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