Olgun Elicin1, Lluís Nisa2, Alan Dal Pra3, Beat Bojaxhiu3, Marco Caversaccio4, Michael Schmücking3, Daniel M Aebersold5, Roland Giger4. 1. Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. Electronic address: olgun.elicin@insel.ch. 2. Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Department of Otorhinolaryngology - Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Department of Clinical Research, University of Bern, Switzerland. 3. Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. 4. Department of Otorhinolaryngology - Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Switzerland. 5. Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Department of Clinical Research, University of Bern, Switzerland.
Abstract
BACKGROUND AND PURPOSE: Lymph node metastases of head and neck cancer are considered one of the most negative prognostic factors. While outcomes and feasibility of chemo-radiotherapy ((C)RT) with or without adjuvant planned neck dissection (ND) in organ-preservation treatment strategy have been addressed, the role of ND before (C)RT, called up-front neck dissection (UFND), is not clearly established. This review provides a critical appraisal of UFND. MATERIAL AND METHODS: Articles were identified with a systematic approach. Outcomes included post-UFND delay of (C)RT, surgical complications, radiation toxicity and oncologic outcome. RESULTS: Fifteen studies met inclusion criteria, totaling 607 patients undergoing UFND. Part of the data suggest advantages toward less surgical complications compared with salvage ND, decreased serious acute radiation toxicity and better oncological outcomes when compared with (C)RT alone. The overall heterogeneity of the analyzed data does not allow a meta-analysis that provides high-quality evidence in favor or against UFND. CONCLUSIONS: Due to lack of well-designed randomized trials, it is difficult to assess the role of UFND in organ-preserving (C)RT setting of head and neck cancer.
BACKGROUND AND PURPOSE: Lymph node metastases of head and neck cancer are considered one of the most negative prognostic factors. While outcomes and feasibility of chemo-radiotherapy ((C)RT) with or without adjuvant planned neck dissection (ND) in organ-preservation treatment strategy have been addressed, the role of ND before (C)RT, called up-front neck dissection (UFND), is not clearly established. This review provides a critical appraisal of UFND. MATERIAL AND METHODS: Articles were identified with a systematic approach. Outcomes included post-UFND delay of (C)RT, surgical complications, radiation toxicity and oncologic outcome. RESULTS: Fifteen studies met inclusion criteria, totaling 607 patients undergoing UFND. Part of the data suggest advantages toward less surgical complications compared with salvage ND, decreased serious acute radiation toxicity and better oncological outcomes when compared with (C)RT alone. The overall heterogeneity of the analyzed data does not allow a meta-analysis that provides high-quality evidence in favor or against UFND. CONCLUSIONS: Due to lack of well-designed randomized trials, it is difficult to assess the role of UFND in organ-preserving (C)RT setting of head and neck cancer.
Authors: Finbar Slevin; Ekin Ermiş; Sriram Vaidyanathan; Mehmet Sen; Andrew F Scarsbrook; Robin Jd Prestwich Journal: Clin Med Insights Oncol Date: 2017-06-14
Authors: Pavel Dulguerov; Martina A Broglie; Guido Henke; Marco Siano; Paul Martin Putora; Christian Simon; Daniel Zwahlen; Gerhard F Huber; Giorgio Ballerini; Lorenza Beffa; Roland Giger; Sacha Rothschild; Sandro V Negri; Olgun Elicin Journal: Front Oncol Date: 2019-10-24 Impact factor: 6.244