Planned neck dissection following chemo-radiotherapy in advanced HNSCC
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BioMed Central
Open Access
Review
Planned neck dissection following chemo-radiotherapy in advanced HNSCC Tejpal Gupta*1 and Jai Prakash Agarwal2 Address: 1Department of Radiation Oncology, Clinical Research Centre, Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Centre, Kharghar, Navi Mumbai: 410208, INDIA and 2Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai: 400 012, INDIA Email: Tejpal Gupta* - [email protected]; Jai Prakash Agarwal - [email protected] * Corresponding author
Published: 17 September 2004 International Seminars in Surgical Oncology 2004, 1:6
doi:10.1186/1477-7800-1-6
Received: 30 June 2004 Accepted: 17 September 2004
This article is available from: http://www.issoonline.com/content/1/1/6 © 2004 Gupta and Agarwal; licensee BioMed Central Ltd. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
chemo-radiotherapyHNSCCand neck dissection
Abstract Background: Neck dissection has traditionally played an important role in the management of patients with regionally advanced head and neck squamous cell carcinoma (HNSCC) treated with radical radiotherapy alone. However, with the incorporation of chemotherapy in the therapeutic strategy for advanced HNSCC and resultant improvement in outcome the routine use of post chemo-radiotherapy neck dissection is being questioned. Methods: Published data for this review was identified by systematically searching MEDLINE, CANCERLIT & EMBASE databases from 1995 until date with restriction to the English language. Results: There is lack of high quality evidence on the role of planned neck dissection in advanced HNSCC treated with chemo-radiotherapy. A systematic literature search could identify only one small randomized controlled trial (Level I evidence) addressing this issue, albeit with major limitations. Upfront neck dissection followed by chemo-radiotherapy resulted in better diseasespecific survival as compared to chemoradiation only. Several single arm prospective and retrospective reports were also identified with significant heterogeneity and often-contradictory conclusions. Conclusions: Planned neck dissection after radical chemo-radiotherapy achieves a high level of regional control, but its ultimate benefit is limited to a small subset of patients only. Unless there are better non-invasive ways to identify residual viable disease, the role of such neck dissection shall remain debatable. A large randomized controlled trial addressing this issue is needed to clarify its role and provide evidence-based answers.
Introduction The optimal management of the neck in loco-regionally advanced head & neck squamous cell carcinomas (HNSCC) following primary chemo-radiotherapy
remains controversial [1,2]. Traditionally neck dissection (Fig 1) was thought to improve neck con
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