The Role of Neck Dissection in Squamous Cell Carcinoma of the Head and Neck
Lymph node metastases in the neck are a major prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). Assessment and treatment of lymph nodes in the neck are of utmost importance. Inappropriate management of lymph node metastases can result in regional failure. Radical neck dissection has been and is still considered the “gold standard” for the surgical management of lymph node metastases of HNSCC. However, the philosophy of treatment of the neck has evolved during the last decades. Surgeons progressively realized that extensive neck dissections were associated with a higher morbidity but not always with a better oncologic outcome than more limited procedures. Today, a comprehensive therapeutic approach of the neck is multidisciplinary, taking into account the patient’s quality of life without jeopardizing cure and survival. A better understanding of the patterns of lymph node metastasis promoted the use of selective neck dissection in selected patients. Sentinel lymph node biopsy is a reliable diagnostic procedure for staging the neck in node-negative early oral cavity squamous cell carcinoma. With increasing use of chemoradiation in locally advanced HNSCC, paradigms are evolving. Currently, there are strong arguments supporting the position that neck dissection is no longer justified in patients without clinically residual disease in the neck.
KeywordsHead and neck cancer Neck dissection Chemoradiotherapy Squamous cell carcinoma Neck metastases
Compliance with Ethics Guidelines
Conflict of InterestMarc Hamoir, Sandra Schmitz, and Vincent Grégoire declare that they have no conflict of interest.
Human and Animal Rights and Informed ConsentThis article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Rouvière H. Anatomie Humaine Descriptive et Topographique. 6th ed. Paris: Masson et Cie; 1948. p. 226–30.Google Scholar
- 3.Spiessl B, Beahrs OH, Hermanek P, et al. TNM Atlas. Illustrated Guide to the TNM/pTNM classification of malignant tumors. 3rd ed. Berlin: Springer; 1992.Google Scholar
- 6.Hermanek P, Henson DE, Hutter RVP, et al., editors. TNM Supplement 1993. A commentary on uniform use. Berlin: Springer; 1993.Google Scholar
- 8.Sobin LH, Gospodarowicz MK, Wittekind CH. TNM classification of malignant tumours. 7th ed. Hoboken: Wiley-Blackwell; 2009.Google Scholar
- 20.Clayman GL, Frank DK. Selective neck dissection of anatomically appropriate levels is as efficacious as modified radical neck dissection for elective treatment of the clinically negative neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. Arch Otolaryngol Head Neck Surg. 1998;124:348–52.PubMedCrossRefGoogle Scholar
- 39.•Govers TM, Hannink G, Merkx MA, Takes RP, Rovers MM. Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: a diagnostic meta-analysis. Oral Oncol. 2013;49:726–32. This is the largest meta-analysis on sentinel lymph node biopsy published so far. Most of these patients had oral cavity squamous cell. The high sensitivity supports a role in the diagnostic work-up of oral squamous cell carcinoma.PubMedCrossRefGoogle Scholar
- 47.Lingeman RE, Helmus C, Stephens R, et al. Neck dissection. Radical or conservative. Ann Otol. 1977;86:737–44.Google Scholar
- 54.Carew JF, Singh B, Shah JP. Cervical lymph nodes. In: Shah JP, Johnson NW, Batsakis JG, Dunitz M, editors. Oral cancer. New York: Thieme; 2003. p. 215–49.Google Scholar
- 72.Lango MN, Andrews GA, Ahmad S, et al. Postradiotherapy neck dissection for head and neck squamous cell carcinoma: pattern of pathologic residual carcinoma and prognosis. Head Neck. 2009;31:328–37.Google Scholar
- 74.•Hamoir M, Ferlito A, Schmitz S, et al. The role of neck dissection in the setting of chemoradiation therapy for head and neck squamous cell carcinoma with advanced neck disease. Oral Oncol. 2012;48:203–10. This article reviews all the available literature on the role of neck dissection after chemoradiotherapy in patients with head and neck squamous cell carcinoma with advanced regional disease. Because of the availability of improved diagnostic follow-up modalities, there are many arguments supporting that planned neck dissection is no longer necessary for patients with complete response.PubMedCrossRefGoogle Scholar
- 76.Waldron JN, Gilbert RW, Eapen L, et al. Results of an Ontario Clinical Oncology Group (OCOG) prospective cohort study on the use of FDG PET/CT to predict the need for neck dissection following radiation therapy of head and neck cancer (HNC). J Clin Oncol. 2011;29(Suppl): [Abstract 5504].Google Scholar
- 80.••Porceddu S, Pryor DI, Burmeister E, et al. Results of a prospective study of positron emission tomography-directed management of residual abnormalities in node-positive head and neck cancer after definitive radiotherapy with or without systemic therapy. Head Neck. 2011;33:1675–82. This prospective study demonstrates that PET-directed management of the neck after definitive chemoradiotherapy in N+ head and neck squamous cell carcinoma appropriately spares neck dissections in patients with PET-negative, residual nodal abnormalities without compromising isolated nodal control.PubMedCrossRefGoogle Scholar
- 84.•Dhiwakar M, Robbins KT, Vieira F, Rao K, Malone J. Selective neck dissection as an early salvage intervention for clinically persistent nodal disease following chemoradiation. Head Neck. 2012;34:188–93. This is a retrospective study on patients who subsequently underwent selective neck dissections for early salvage of clinically persistent nodal disease after definitive chemoradiation for advanced head and neck squamous cell carcinoma. Recurrence in the dissected neck was reported in only one patient. Although retrospective, these data show that selective neck dissection is an effective early salvage intervention for persistent nodal disease in patients treated with chemoradiation.PubMedCrossRefGoogle Scholar
- 85.•Robbins KT, Dhiwakar M, Vieira F, Rao K, Malone J. Efficacy of super-selective neck dissection following chemoradiation for advanced head and neck cancer. Oral Oncol. 2012;48:1185–9. This retrospective study on 30 patients shows that superselective neck dissection is an effective intervention for patients with advanced head and neck cancer treated with chemoradiation whose risk for residual nodal disease is confined to one level.PubMedCrossRefGoogle Scholar