Factors influencing the improvement rate of shoulder joint abduction range of motion after early surgery with head and neck cancer patients who had undergone neck dissection in which the spinal accessory nerve was preserved

Abstract Background This study aims to assess systemic and local risk factors influencing the development of osteoradionecrosis of the jaws (ORN) and its incidence in head and neck cancer patients undergoing radiotherapy.Methods This was a retrospective cohort study of 620 adult patients following radiation for a head and neck cancer in 2011 or 2012. Results Of the 181 patients who did not require any extraction, the incidence of ORN was 0.5%. Of the 266 patients with 1491 dental extractions (mean 5.5 teeth per patient) performed before radiotherapy, the incidence of ORN was 3.7%. ORN was always observed in extraction sites located in the field of radiation. No dental extractions were done during radiotherapy. Of the 20 patients with 53 dental extractions (mean 2.7 teeth per patient) performed after radiotherapy, 15 teeth were located in the field of radiation. No case of ORN was reported in that group. For edentulous patients, ORN incidence was 1.7%. Conclusion Within the limitations of this study, the incidence of ORN can be minimized with a meticulous pre-radiotherapy dental examination, a comprehensive treatment plan and diligent post-radiotherapy follow-ups conducted by an experienced multidisciplinary team.

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Less is Enough: Outcome of Bimodality Definitive Concurrent Chemoradiation does not Differ from that of Trimodality Upfront Neck Dissection Followed by Adjuvant Treatment for >6 cm Bulky Lymph Node (N3) Head and Neck Cancer

10.20944/preprints201903.0249.v1 ◽

2019 ◽

Author(s):

Wan-Yu Chen ◽

Tseng-Cheng Chen ◽

Shih-Fan Lai ◽

Tony Hsiang-Kuang Liang ◽

Bing-Shen Huang ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Dissection ◽

Cancer Patients ◽

Neck Cancer ◽

Primary Tumor ◽

Treatment Modalities ◽

Recurrence Free Survival ◽

Tumor Treatment ◽

Free Survival

Currently, data regarding optimal treatment modality, response, and outcome specifically for N3 head and neck cancer are lacking. This study aimed to compare the treatment outcomes between definitive concurrent chemoradiotherapy (CCRT) to the neck and upfront neck dissection followed by adjuvant CCRT. 93 N3 squamous cell carcinoma head and neck cancer patients were included. Primary tumor treatment was divided to definitive CCRT (CCRT group) or curative surgery followed by adjuvant CCRT (surgery group). Neck treatment was also classified into two treatment modalities: definitive CCRT to the neck (CCRT group) or curative neck dissection followed by adjuvant CCRT (neck dissection group). Overall, the 2-year overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 51.8%, 47.3%, 45.6%, and 43.6%, respectively. In both oropharyngeal cancer and nonoropharyngeal cancer patients, in terms of OS, LRFS, RRFS or DMFS no difference was noted regarding primary tumor treatment (CCRT vs. surgery) or neck treatment (CCRT vs. neck dissection). In summary, N3 neck patients treated with definitive CCRT can achieve similar outcomes to those treated with upfront neck dissection followed by adjuvant CCRT. Cautions should be made to avoid overtreatment for this group of patients.

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