The Extent of Neck Dissection Among Patients Who Receive Adjuvant Radiotherapy for HNSCC and Its Effect on Disease-Specific and Overall Survival

The study objective was to assess if the extent of neck dissection among patients who receive adjuvant radiotherapy affects regional recurrence and survival. This was a retrospective study of patients who had clinical metastatic mucosal primary squamous cell carcinoma (SCC) to cervical lymph nodes done at Roswell Park Comprehensive Cancer Center, Buffalo, New York from 2004 to 2015. Patients with previous radiotherapy and/or chemotherapy were excluded. All patients had surgery to the primary tumor and the neck followed by adjuvant (chemo) radiation. Patients have been divided into 2 groups according to type of neck dissection as either selective neck dissection (SND) or comprehensive neck dissection (CND). The extent of neck dissection was determined by surgeon preference. All patients received postoperative radiotherapy to the primary tumor bed and to the neck with or without chemotherapy. Main outcomes were measured in regional recurrence and overall survival. In our study, 74 patients were included. Among the 2 groups of patients, 3-year outcomes for regional recurrence occurred in 4 (7.1%) of 56 patients in the SND group and 2 (11.1%) of 18 patients in the CND group. Overall survival was 29 (51.8%) of 56 patients in the SND group and 11 (61.1%) of 18 patients in the CND group ( P = .497). Among patients who died in each cohort, disease-specific death was 20 (74.1%) of 27 patients in the SND group and 5 (71.4%) of 7 patients in the CND group ( P = .79).The overall and disease-specific survival differences between the SND and CND cohorts were not statistically significant. In conclusion, SND, combined with proper adjuvant treatment, achieved regional control and survival rates comparable to CND.

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In patients with metastatic cutaneous head and neck squamous cell carcinoma to cervical lymph nodes, the extent of neck dissection does not influence outcome

The Journal of Laryngology & Otology ◽

10.1017/s0022215112002101 ◽

2012 ◽

Vol 127 (S1) ◽

pp. S2-S7 ◽

Cited By ~ 14

Author(s):

J T Wang ◽

C E Palme ◽

A Y Wang ◽

G J Morgan ◽

V Gebski ◽

...

Keyword(s):

Overall Survival ◽

Neck Dissection ◽

Adjuvant Radiotherapy ◽

Radical Neck Dissection ◽

Disease Free Survival ◽

Selective Neck Dissection ◽

Cervical Lymph Nodes ◽

Free Survival ◽

Modified Radical Neck Dissection ◽

Disease Free

AbstractBackground:This study aimed to compare recurrence and survival in patients undergoing either selective neck dissection or modified radical neck dissection to treat metastatic cutaneous head and neck squamous cell carcinoma to the cervical lymph nodes (levels I–V) only.Methods:Twenty-eight year, retrospective analysis of a prospectively maintained database from a tertiary referral hospital, with a minimum follow up of two years.Results:There were 122 eligible patients: 96 males (79 per cent) and 26 (21 per cent) females (median age, 66 years). Sixty-six patients (54 per cent) underwent selective neck dissection and 56 (46 per cent) modified radical neck dissection. The former patients had a lower rate of regional recurrence compared with the latter (17 vs 23 per cent, respectively). There was no significant difference in five-year overall survival (61 vs 57 per cent, respectively) or five-year disease-free survival (74 vs 60 per cent, respectively), comparing the two groups. Overall survival and disease-free survival were significantly improved by the addition of adjuvant radiotherapy.Conclusion:We found no difference in outcome in patients undergoing selective versus modified radical neck dissection. Adjuvant radiotherapy significantly improved outcome.

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S174 – Therapeutic Selective Neck Dissection Outcomes

Otolaryngology ◽

10.1016/j.otohns.2008.05.348 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P134-P134

Author(s):

Peter M Shepard ◽

Olson Jordan ◽

Glen E Leverson ◽

Paul M Harari ◽

Gregory K Hartig

Keyword(s):

Neck Dissection ◽

Primary Tumor ◽

Postoperative Radiotherapy ◽

Radical Neck Dissection ◽

Retrospective Chart Review ◽

Regional Recurrence ◽

Selective Neck Dissection ◽

Nodal Metastases ◽

Neck Node ◽

Primary Tumor Site

Objectives To examine the efficacy of selective neck dissection in patients with nodal metastases from head and neck squamous cell carcinoma. Methods A retrospective chart review was performed on a cohort of 156 subjects with clinically positive regional nodal metastases, whose initial management included neck dissection by a single surgeon from 1994–2007. 69 subjects underwent selective neck dissection (SND), while 87 underwent radical or modified radical neck dissection (R/MRND). The majority of subjects (81%) received postoperative radiotherapy. Primary outcomes included 3-year regional recurrence and 5-year overall survival, using Kaplan-Meier analysis. Results Following exclusion of subjects with local recurrence before or concurrent with regional recurrence, there were 4 (8.6%) regional recurrences in the SND group and 15 (22%) in the R/MRND group. 2 and 6 of these recurrences involved the contralateral neck in each group, respectively. Using multivariate analysis we adjusted for differences in nodal and primary tumor stage, primary tumor site, year of surgery, extracapsular spread, and postoperative radiotherapy rates. The lower regional recurrence rate in the SND group remained statistically significant (p=0.02). Overall 5-year survival was 46% in the SND group vs. 34% in the R/MRND group (p=0.23). Conclusions These results demonstrate excellent regional disease control following SND in patients with neck node metastases. SND with adjunctive radiotherapy remains our preferred approach for most patients undergoing therapeutic neck dissection.

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Management of Parotid Metastatic Cutaneous Squamous Cell Carcinoma: Regional Recurrence Rates and Survival

Otolaryngology ◽

10.1177/0194599818764348 ◽

2018 ◽

Vol 159 (2) ◽

pp. 293-299 ◽

Cited By ~ 8

Author(s):

Nir Hirshoren ◽

Olivia Ruskin ◽

Lachlan J. McDowell ◽

Matthew Magarey ◽

Stephen Kleid ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Adjuvant Radiotherapy ◽

Cutaneous Squamous Cell Carcinoma ◽

Regional Recurrence ◽

Treatment Modalities ◽

Cancer Center ◽

Cervical Lymph Nodes

Objectives Extent of parotidectomy and neck dissection for metastatic cutaneous squamous cell carcinoma (cSCC) to the parotid is debated. We describe our experience, analyzing outcomes (overall survival and regional recurrence) associated with surgical extent and adjuvant treatment. Study Design A retrospective cohort study of parotidectomy with or without neck dissection for metastatic cSCC. Setting A tertiary referral cancer center in Australia. Subjects and Methods The study group consisted of patients with metastatic cSCC involving the parotid gland who underwent a curative-intent parotidectomy (superficial or total), with or without neck dissection, between 2003 and 2014. Demographic and clinical data, treatment modalities, and outcome parameters were collected from the electronic institutional database. Results Of 78 patients, 65 underwent superficial parotidectomy. Median follow-up was 6.5 years. Sixty-four patients (82%) patients received adjuvant radiotherapy. Cervical lymph nodes were involved in 6 (24%) elective neck dissections. Involved preauricular, facial, external jugular, and occipital nodes occurred in 36.9%. Adjuvant radiotherapy was associated with improved 5-year survival—50% (95% CI, 36%-69%) versus 20% (95% CI, 6%-70%)—and improved 2-year regional control: 89% (95% CI, 67%-100%) versus 40% (95% CI, 14%-100%). The ipsilateral parotid bed recurrence rate was 3.7% for those who received adjuvant radiotherapy and 27% for those who did not receive radiotherapy. Conclusion This study supports surgery plus adjuvant radiotherapy as a standard of care for metastatic cSCC. The low incidence of parotid bed recurrence with this approach suggests that routine elective deep lobe resection may not be required.

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Serendipitous Detection of Cervical Nodal Metastasis in Glomus Jugulare

Indian Journal of Neurosurgery ◽

10.1055/s-0038-1639383 ◽

2018 ◽

Vol 07 (03) ◽

pp. 256-259

Author(s):

Shruti Venkitachalam ◽

Rayappa Chinnusamy ◽

Narendranath Ashok ◽

Swatee Halbe

Keyword(s):

Radiation Therapy ◽

Lymph Nodes ◽

Neck Dissection ◽

Similar Pattern ◽

Adjuvant Radiotherapy ◽

Nodal Metastasis ◽

Cervical Lymph Nodes ◽

Glomus Jugulare ◽

History Of

AbstractWe present the case of a 50-year-old man who presented to us with a history of having received radiation therapy for a glomus jugulare tumor. He had been on regular follow-up with serial imaging scans. The MRI done after 4 years of treatment revealed an interval increase in size. Carotid angiogram revealed, in addition to the glomus, multiple lymph nodes of similar pattern of vascularity, well lateral to the carotid sheath, in the ipsilateral neck. He underwent resection of the tumor and a neck dissection. Histopathology confirmed metastatic glomus jugulare in the cervical lymph nodes. He received adjuvant radiotherapy and is doing well.

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HSR19-092: Adjuvant Radiotherapy Is Associated with Improved Overall Survival for Resected Alveolar Ridge Squamous Cell Carcinoma With Adverse Pathologic Features

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7170 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. HSR19-092

Author(s):

Corbin D. Jacobs ◽

Daniel J. Rocke ◽

Russel R. Kahmke ◽

Hannah Williamson ◽

Gita Suneja ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Squamous Cell Carcinoma ◽

Risk Factor ◽

Cell Carcinoma ◽

Primary Tumor ◽

Adjuvant Radiotherapy ◽

Tumor Grade ◽

Alveolar Ridge ◽

Pathologic Features

Background: Alveolar ridge (AR) squamous cell carcinoma (SCC) is poorly represented on prospective clinical trials. Adjuvant management is extrapolated from more common head and neck SCC, including those with a stronger influence from the human papillomavirus. The objective of this analysis is to determine the association between adjuvant radiotherapy (RT) and overall survival (OS) for resected ARSCC based on adverse pathologic features. Methods: Adult subjects in the National Cancer Database diagnosed with invasive nonmetastatic ARSCC between 2010–2014 were identified. Exclusion criteria included prior malignancy, no/unknown surgery, unknown receipt of RT, RT dose <50 Gy or >80 Gy, RT fractions >68, T1–2N0 disease without identifiable NCCN-defined risk factors (positive margin, lymphovascular invasion, pT3–4, N2–3, extranodal extension, or level IV/V nodal metastasis), and unknown/missing NCCN risk factor data. Log-rank test stratified by RT and Cox regression analyses with respect to OS were performed. Results: 1,450 subjects met inclusion criteria, of which 825 (57%) received RT. Median follow-up was 27 months. Adjuvant RT was associated with improved OS (72% vs 65% at 2 years, log-rank P=.004). Stratified by number of NCCN-defined risk factors, adjuvant RT was associated with improved OS for subjects with 2 (74% vs 58% at 2 years, log-rank P<.001) and ≥3 (54% vs 29% at 2 years, log-rank P<.001) risk factors. Adjuvant RT was significantly associated with improved OS on univariate (HR, 0.80; 95% CI, 0.68–0.94; P=.008) and multivariate (HR, 0.72; 95% CI, 0.60–0.87; P=.001) analyses, the latter adjusted for age, comorbidity score, and adverse pathologic features. Each NCCN-defined risk factor, high tumor grade, primary tumor ≥3 cm, and ≥5% nodal positivity (number of pathologic nodes positive among nodes resected) were significantly associated with worse OS on univariate and multivariate analyses. Conclusions: Adjuvant RT for resected ARSCC with adverse pathologic features is associated with significantly improved OS. Subjects with a primary tumor ≥3 cm, high tumor grade, and ≥5% nodal positivity in addition to the NCCN-defined risk factors should be considered for adjuvant RT.

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Regional Control of Melanoma Neck Node Metastasis After Selective Neck Dissection With or Without Adjuvant Radiotherapy

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archoto.2009.80 ◽

2009 ◽

Vol 135 (8) ◽

pp. 795 ◽

Cited By ~ 13

Author(s):

Olga Hamming-Vrieze ◽

Alfons J. M. Balm ◽

Wilma D. Heemsbergen ◽

Thijs Hooft van Huysduynen ◽

Coen R. N. Rasch

Keyword(s):

Neck Dissection ◽

Adjuvant Radiotherapy ◽

Selective Neck Dissection ◽

Neck Node ◽

Node Metastasis ◽

Regional Control ◽

Neck Node Metastasis

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Neck Dissection in Relation With Disease-Free, Disease-Specific, and Overall Survival of Patients With Squamous Cell Cancer of the Oral Cavity

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000001023 ◽

2014 ◽

Vol 25 (6) ◽

pp. 1992-1997 ◽

Cited By ~ 8

Author(s):

Georgios Koloutsos ◽

Konstantinos Vahtsevanos ◽

Athanassios Kyrgidis ◽

Nikolaos Kechagias ◽

Stefanos Triaridis ◽

...

Keyword(s):

Overall Survival ◽

Oral Cavity ◽

Neck Dissection ◽

Squamous Cell ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Disease Free ◽

Disease Specific

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Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

Cancers ◽

10.3390/cancers14010164 ◽

2021 ◽

Vol 14 (1) ◽

pp. 164

Author(s):

Shin-Cheh Chen ◽

Shih-Che Shen ◽

Chi-Chang Yu ◽

Ting-Shuo Huang ◽

Yung-Feng Lo ◽

...

Keyword(s):

Neck Dissection ◽

Distant Metastasis ◽

Primary Tumor ◽

Medical Center ◽

Significant Risk ◽

Nodal Metastasis ◽

Time Interval ◽

Selective Neck Dissection ◽

Tumor Surgery ◽

Breast Cancer Patients

We retrospectively enrolled 139 patients who developed metachronous isolated supraclavicular lymph node metastasis (miSLNM) from 8129 consecutive patients who underwent primary surgery between 1990 and 2008 at a single medical center. The median age was 47 years. The median follow-up time from date of primary tumor surgery was 73.1 months, and the median time to the date of neck relapse was 43.9 months in this study. Sixty-one (43.9%) patients underwent selective neck dissection (SND). The 5-year distant metastasis-free survival (DMFS), post-recurrence survival, and overall survival (OS) rates in the SND group were 31.1%, 40.3%, and 68.9%, respectively, whereas those of the no-SND group were 9.7%, 32.9%, and 57.7%, respectively (p = 0.001). No SND and time interval from primary tumor surgery to neck relapse ≤24 months were the only significant risk factors in the multivariate analysis of DMFS (hazard ratio (HR), 1.77; 95% confidence interval (CI), 1.23–2.56; p = 0.002 and HR, 1.76, 95% CI, 1.23–2.52; p = 0.002, respectively) and OS (HR, 1.77; 95% CI, 1.22–2.55; p = 0.003 and HR, 3.54, 95% CI, 2.44–5.16; p < 0.0001, respectively). Multimodal therapy, including neck dissection, significantly improved the DMFS and OS of miSLNM. Survival improvement after miSLNM control by intensive surgical treatment suggests that miSLNM is not distant metastasis.

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POST-SURGICAL SHOULDER REHABILITATION OF SELECTIVE NECK DISSECTION WITH PECTORALIS MAJOR MYOCUTANEOUS FLAP RECONSTRUCTION IN “SICK” SYNDROME PATIENTS

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i3.1130 ◽

2021 ◽

Vol 10 (3) ◽

pp. 2933-2936

Author(s):

Waqar M Naqvi

Keyword(s):

Lymph Nodes ◽

Neck Dissection ◽

Positive Impact ◽

Myocutaneous Flap ◽

Rehabilitation Program ◽

Pectoralis Major ◽

Pectoralis Major Myocutaneous Flap ◽

Selective Neck Dissection ◽

Cervical Lymph Nodes ◽

Shoulder Dysfunction

Selective neck dissection (SND) is a surgical procedure developed to remove cervical lymph nodes at the risk of invasion metastasis. It is distinguished from radical neck dissections wherein there is the retention of one or more groups of lymph nodes. In this case, a 45-year-old male shopkeeper diagnosed with malignancy of lower anterior alveolus from 45-36 region (stage IVA –T4a N2Cm0) underwent SND, segmental mandibulectomy, and reconstruction with pectoralis major myocutaneous flap (PMMC flap) on the left side. On assessment, before the SND, Scapular mal positioning, inferior medial border prominence, coracoid pain, and dyskinesia of scapular movement (SICK) were identified. The patient was referred for physiotherapy with the complaint of inability to maintain saturation, difficulty in decannulation, and shoulder dysfunction on postoperative day 3 (POD-3). Chest physiotherapy comprising of breathing and suctioning techniques aided early decannulation. Furthermore, a prompt shoulder rehabilitation program for six months had a positive impact on the overall functioning and quality of life of the patient.

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Dural Invasion Predicts the Laterality and Development of Neck Metastases in Esthesioneuroblastoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625977 ◽

2018 ◽

Vol 79 (05) ◽

pp. 495-500 ◽

Cited By ~ 1

Author(s):

John Marinelli ◽

Jamie Van Gompel ◽

Michael Link ◽

Eric Moore ◽

Kathryn Van Abel ◽

...

Keyword(s):

Overall Survival ◽

Survival Rates ◽

Regional Recurrence ◽

Recurrence Free Survival ◽

Cervical Lymph Nodes ◽

Term Survival ◽

Free Survival ◽

Tertiary Referral Center ◽

Neck Disease ◽

Neck Metastases

Objectives Neck metastases in patients with esthesioneuroblastoma (ENB) constitute the most significant predictor of poor long-term survival. Recently, researchers discovered the existence of dural lymphatic channels that drain to the cervical lymph nodes. From this physiologic basis, we hypothesized that patients with ENB who develop dural invasion (DI) would exhibit a proclivity for neck metastases. Design Retrospective review. Setting Tertiary referral center. Participants All patients treated for ENB from January 1, 1994 to December 31, 2015. Main Outcome Measures Incidence, laterality, and recurrence rate of neck metastases by DI status. Results Sixty-one patients were identified (38% female; median age 49, range, 10–80), 34 (56%) of whom had DI and 27 (44%) did not. Of patients with DI, 50% presented with or developed neck disease following treatment compared with just 22% of those without DI (p = 0.026). Bilateral neck disease was more common in patients with DI (11/34, 32%) compared with those without (2/27, 7%) (p = 0.018). Five-year regional recurrence-free survival rates were 88% for those without and 64% for those with DI (p = 0.022). Kadish C patients with DI were more likely to develop regional recurrence when compared with Kadish C without DI and Kadish A/B (p = 0.083). Further, Kadish C patients with DI displayed worse overall survival than Kadish C without DI and Kadish A/B. Kadish D patients displayed the worst overall survival. The difference in overall survival among these four groups was significant (p < 0.001). Conclusion DI by ENB is associated with increased incidence of cervical nodal metastases, bilateral neck disease, worse regional recurrence-free survival, and poorer overall survival. These data support the division of Kadish C by DI status.

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