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Neck management in head and neck squamous cell carcinomas: where do we stand?

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Abstract

Head and neck squamous-cell carcinomas (HNSCCs) have a significant lymph node tropism. This varies considerably depending on the primary tumor site and the Human Papillomavirus (HPV) status of the disease. The best therapeutic option, between up-front lymph node dissection and chemoradiotherapy (CRT) +/− followed by lymph node dissection in case of persistent lymphadenopathy or regional relapse, remains unclear. The purpose of this review is to discuss the pros and cons related to the different approaches of the neck management in HNSCC. A narrative review of the management of the cervical lymph nodes was undertaken. Searches of PubMed database were performed using the terms ‘neck management’ OR ‘cervical lymphadenopathies’ AND ‘head and neck neoplasms’. Recent advances in imaging, pathological analysis, surgery and radiotherapy let to personalize the type of lymph node dissection and, the volumes of radiation therapy. Excluding inoperable patients and unresectable diseases, N3 lymphadenopathies, as well as bulky N2 stages, specifically HPV− or necrotic nodes, would be in favor of an up-front surgical approach, while HPV+ diseases, and lymphadenopathies of unknown primary would support CRT first. However, efficacy of such strategies is challenged by a significant morbidity in the medium and long terms. In the absence of higher level of evidence, the decision-making tools for the neck dissection before or after the CRT are based on the Mehanna’s trial and retrospective studies with significant biases. Consequently, the approaches and the ensuing outcomes remain not homogenous depending on the centers’ experience, in the context of limited data, especially for N2–3 HPV− HNSCC.

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Authors and Affiliations

  1. Radiation Oncology Department, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière Charles-Foix, Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Guillaume Klausner & Eivind Blais

  2. Radiation Oncology Department, Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland

    Idriss Troussier, Thomas Zilli, Raymond Miralbell & Francesca Caparrotti

  3. Head and Neck Surgery Department, Centre Hospitalier Universitaire (CHU) de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France

    Florent Carsuzaa

  4. Radiation Oncology Department, François Baclesse Center/ARCHADE, Normandy University, 3 Avenue du Général Harris, 14000, Caen, France

    Juliette Thariat

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  1. Guillaume Klausner
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  2. Idriss Troussier
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Correspondence to Guillaume Klausner.

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Klausner, G., Troussier, I., Blais, E. et al. Neck management in head and neck squamous cell carcinomas: where do we stand?. Med Oncol 36, 40 (2019). https://doi.org/10.1007/s12032-019-1265-1

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