• 2/11/2006
  • New York, NY
  • staff
  • CancerPage.com

Selective neck dissection (SND) can achieve acceptable regional recurrence rates in patients with T1 or T2, N1 head and neck squamous cell cancer (HNSCC), according to Brazilian researchers. However, this operation may not be suitable for patients with advanced T tumors or N2b disease as regional recurrence rates are increased.

In the January issue of Archives of Otolaryngology: Head and Neck Surgery, Dr. Claudio Roberto Cernea and colleagues at Sao Paulo Medical School note that radical neck dissection, in which all node levels are removed, is the standard treatment for node-positive head and neck cancers. However, this operation can result in considerable morbidity, so there has been a move to less extensive procedures that, in theory, do not compromise oncologic control.

SND, in which one or more node levels is preserved, has been traditionally applied to node-negative malignancies, but in recent years, there have been reports of its use for node-positive disease.

The researchers studied 191 patients with node-positive disease who underwent 256 neck dissections at one center between 1999 and 2002.

The study focused on 34 SNDs that were performed in 28 patients. Of these patients, 2 had T1 disease, 2 had T2, 7 had T3, and 17 had T4. The breakdown for the N category was 8 patients with N1 disease, 2 with N2a, 7 with N2b, and 11 with N2c.

Four patients (11.8%) experienced regional recurrences following SND, the report indicates. All of these patients had T3 or T4 disease and three of the four had N2b or greater nodal disease.

“SND may be indicated in very carefully selected cases of node-positive HNSCC,” the researchers conclude, “but our study suggests that caution should be exercised in patients with an advanced T stage and/or with multiple clinically positive neck nodes, even when postoperative chemotherapy is used.”

Source:
Arch Otolaryngol Head Neck Surg 2006;132:79-81