Annals of Surgical Oncology

, Volume 19, Issue 7, pp 2311–2319

Management of the Neck in the Setting of Definitive Chemoradiation: Is There a Consensus? A GETTEC Study

  • Juliette Thariat
  • Marc Hamoir
  • Renaud Garrel
  • Alain Cosmidis
  • Olivier Dassonville
  • Janot
  • C. A. Righini
  • P. O. Vedrine
  • J. M. Prades
  • J. Lacau-Saint-Guily
  • F. Jegoux
  • O. Malard
  • E. De Mones
  • A. Benlyazid
  • R.-J. Bensadoun
  • B. Baujat
  • J. C. Merol
  • C. Ferron
  • C. Scavennec
  • D. Salvan
  • Y. Mallet
  • S. Moriniere
  • S. Vergez
  • O. Choussy
  • G. Dollivet
  • N. Guevara
  • P. Ceruse
  • D. De Raucourt
  • B. Lallemant
  • G. Lawson
  • P. Lindas
  • M. Poupart
  • S. Duflo
  • Xavier Dufour
Head and Neck Oncology
  • 230 Downloads

Abstract

Background

The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2–3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2–3 or selective ND for residual disease

Methods

We studied the patterns of care in the French-Belgian Groupe d’Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey.

Results

Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND.

Conclusions

Omission of ND based on computed tomographic scan and positron emission tomography–based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus–related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Juliette Thariat
    • 1
  • Marc Hamoir
    • 2
  • Renaud Garrel
    • 3
  • Alain Cosmidis
    • 4
  • Olivier Dassonville
    • 5
  • Janot
    • 6
  • C. A. Righini
    • 7
  • P. O. Vedrine
    • 8
  • J. M. Prades
    • 9
  • J. Lacau-Saint-Guily
    • 10
  • F. Jegoux
    • 11
  • O. Malard
    • 12
  • E. De Mones
    • 13
  • A. Benlyazid
    • 14
  • R.-J. Bensadoun
    • 15
  • B. Baujat
    • 12
    • 16
  • J. C. Merol
    • 17
  • C. Ferron
    • 12
  • C. Scavennec
    • 18
  • D. Salvan
    • 19
  • Y. Mallet
    • 20
  • S. Moriniere
    • 21
  • S. Vergez
    • 22
  • O. Choussy
    • 23
  • G. Dollivet
    • 24
  • N. Guevara
    • 25
  • P. Ceruse
    • 4
  • D. De Raucourt
    • 26
  • B. Lallemant
    • 27
  • G. Lawson
    • 28
  • P. Lindas
    • 29
  • M. Poupart
    • 4
  • S. Duflo
    • 30
  • Xavier Dufour
    • 15
  1. 1.Department of RadiotherapyCenter Antoine-Lacassagne, IUFCNiceFrance
  2. 2.St Luc University HospitalBrusselsBelgium
  3. 3.CHUMontpellierFrance
  4. 4.CHULyonFrance
  5. 5.CALNiceFrance
  6. 6.Institute Gustave RoussyVillejuifFrance
  7. 7.CHUGrenobleFrance
  8. 8.CHCannesFrance
  9. 9.CHUSt EtienneFrance
  10. 10.CHUTenon, ParisFrance
  11. 11.CHURennesFrance
  12. 12.CHUNantesFrance
  13. 13.CHUBordeauxFrance
  14. 14.Centre Claudius RegaudToulouseFrance
  15. 15.CHUPoitiersFrance
  16. 16.CHU BeaujonParisFrance
  17. 17.CHUReimsFrance
  18. 18.CHDraguignanFrance
  19. 19.CHEvryFrance
  20. 20.Centre Oscar LambretLilleFrance
  21. 21.CHUToursFrance
  22. 22.CHUToulouseFrance
  23. 23.CHURouenFrance
  24. 24.CHUNancyFrance
  25. 25.CHU-IUFCNiceFrance
  26. 26.Centre BaclesseCaenFrance
  27. 27.CHUNimesFrance
  28. 28.CHUYvoirBelgium
  29. 29.CHMetzFrance
  30. 30.CHUPointe-a-PitreGuadeloupe

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