MANAGEMENT OF THE NECK IN PATIENTS WITH HEAD AND NECK CANCER TREATED BY CONCURRENT CHEMOTHERAPY AND RADIATION
Section snippets
CHEMORADIATION TRIALS IN HEAD AND NECK CANCER
Formal trials of concurrent chemotherapy and radiation date to the 1970s. Early trials focused on patients with recurrent or inoperable disease. Multidrug combinations given during radiation treatment resulted in toxicity that was greater than expected.10, 11 With the emergence of CP as a single agent with major activity against squamous carcinoma, trials of this drug combined with concurrent radiation were carried out by the Radiation Therapy Oncology Group (RTOG) in the 1970s and early 1980s.
ISSUES RELATED TO CHEMORADIATION AND MANAGEMENT OF THE NECK IN HEAD AND NECK CANCER
At least two questions arise with regard to chemoradiation and its impact on management of the neck in head and neck cancer. One of these is whether chemoradiation impacts the pattern of treatment failure, particularly in the neck. In other words, is there improvement in regional control of head and neck squamous cell cancer with chemoradiation to the extent that surgical treatment philosophies should be altered? A second question is whether chemoradiation alters the complication rate of
IMPACT OF CHEMORADIATION ON REGIONAL CONTROL OF HEAD AND NECK CANCER
The concept of concurrent chemotherapy and XRT is not new, as noted above, but has been refined over the last two decades. Al-Sarraf and colleagues'4 RTOG study established the first safe and effective regimen in a controlled trial. Other than mentioning that one patient had been rendered disease-free by salvage neck dissection, the role of surgery in that trial was not discussed. Subsequent studies have focused on response rates, survival rates, and toxicities of chemotherapy. Although a
COMPLICATIONS OF NECK DISSECTION AFTER CHEMORADIATION
Although increasing numbers of patients with advanced SCCHN are treated in clinical trials and in the community with various chemoradiation protocols, there are very few reports in the medical literature addressing the rate and risk of surgical complications in patients so treated. Corey et al6 reported on a series of patients randomized prospectively to either induction chemotherapy with methotrexate and leucovorin calcium rescue before standard therapy (surgery and/or XRT), or to standard
SUMMARY
The current high level of interest in organ preservation strategies for patients with advanced SCCHN undoubtedly will result in increasing numbers of patients managed initially with chemotherapy and radiation, either sequentially or concurrently. In some protocols, surgery, and neck dissection in particular, will either be mandatory or offered based on the degree of response to treatment and initial stage of neck disease. Head and neck oncologic surgeons need to be involved and at the forefront
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Cited by (31)
Prediction of neck dissection requirement after definitive radiotherapy for head-and-neck squamous cell carcinoma
2012, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :However, the view that nodal disease might be more radioresistant than the primary tumor (1) has led to controversy on the necessity of a planned neck dissection after radiation for patients presenting with advanced nodal disease. This controversy is best demonstrated in the design of Phase III trials during the past two decades because some organ preservation trials mandated postradiation neck dissections, whereas others left the decision of whether to surgically treat the neck at the discretion of the treating physicians (2–10). There is general agreement that patients with less than complete response (CR) should undergo neck dissection to eliminate potential residual viable tumor cells in the nodes (11, 12).
Incidence of isolated regional recurrence after definitive (chemo-) radiotherapy for head and neck squamous cell carcinoma
2009, Radiotherapy and OncologyCitation Excerpt :The overall regional control rate after three years was 80%. This is comparable to data already published [9,22,23]. A total of 11 patients had an isolated regional recurrence (2.99%).
Critical care of the head and neck patient
2003, Critical Care ClinicsOptimization of treatment tactics for patients with oropharyngeal cancer and regional metastases after radical chemoradiotherapy
2023, P.A. Herzen Journal of OncologyNo benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression
2016, European Archives of Oto-Rhino-LaryngologyAccuracy of ultrasonography-guided fine-needle aspiration in detecting persistent nodal disease after chemoradiotherapy
2016, JAMA Otolaryngology - Head and Neck Surgery
Address reprint requests to Robert A. Weisman, MD, Division of Otolaryngology–Head and Neck Surgery, University of California Medical Center of San Diego, 200 W. Arbor Drive, San Diego, CA 92103–8891