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Therapeutic Neck Dissection (therapeutic + neck_dissection)
Selected AbstractsHigh-Risk Cutaneous Squamous Cell Carcinoma without Palpable Lymphadenopathy: Is There a Therapeutic Role for Elective Neck Dissection?DERMATOLOGIC SURGERY, Issue 4 2007JUAN-CARLOS MARTINEZ MD PURPOSE The beneficial role of elective neck dissection (END) in the management of high-risk cutaneous squamous cell carcinoma (CSCC) of the head and neck remains unproven. Some surgical specialists suggest that END may be beneficial for patients with clinically node-negative (N0) high-risk CSCC, but there are few data to support this claim. We reviewed the available literature regarding the use of END in the management of both CSCC and head and neck SCC (HNSCC). METHODOLOGY The available medical literature pertaining to END in both CSCC and HNSCC was reviewed using PubMed and Ovid Medline searches. RESULTS Many surgical specialists recommend that END be routinely performed in patients with N0 HNSCC when the risk of occult metastases is estimated to exceed 20%; however, patients who undergo END have no proven survival benefit over those who are initially staged as N0 and undergo therapeutic neck dissection (TND) after the development of apparent regional disease. There is a lack of data regarding the proper management of regional nodal basins in patients with N0 CSCC. In the absence of evidence-based data, the cutaneous surgeon must rely on clinical judgment to guide the management of patients with N0 high-risk CSCC of the head and neck. CONCLUSIONS Appropriate work-up for occult nodal disease may occasionally be warranted in patients with high-risk CSCC. END may play a role in only a very limited number of patients with high-risk CSCC. [source] Routine inclusion of level IV in neck dissection for squamous cell carcinoma of the larynx: Is it justified?HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2004Avi Khafif MD Abstract Background. Dissection of levels II,IV as part of an elective or therapeutic neck dissection is common practice during laryngectomy for laryngeal squamous cell carcinoma (SCC). The necessity of routine dissection at level IV has recently been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent neck dissections. Methods. The charts of 71 suitable patients were reviewed. Forty-two had supraglottic primary cancers, and 29 had transglottic primary tumors. Levels II,IV had been removed in them all, and their neck specimens were marked according to the levels of the neck. The surgical specimens were pathologically diagnosed. Results. Of 43 patients who underwent elective lateral neck dissection, the only one (2.3%) with level IV metastases also showed metastases at level II. Nine (32%) of the other 28 patients with clinical adenopathy had level IV metastases. Conclusions. Dissection of level IV as part of a therapeutic neck dissection for supraglottic and transglottic SCC is recommended for patients with clinically enlarged lymph nodes, but its necessity in the absence of detectable adenopathy is challenged. © 2004 Wiley Periodicals, Inc. Head Neck26: 309,312, 2004 [source] Adjuvant irradiation for cervical lymph node metastases from melanomaCANCER, Issue 7 2003Matthew T. Ballo M.D. Abstract BACKGROUND The risk of regional disease recurrence after surgery alone for lymph node metastases from melanoma is well documented. The role of adjuvant irradiation remains controversial. METHODS The medical records of 160 patients with cervical lymph node metastases from melanoma were reviewed retrospectively. Of these, 148 (93%) presented with clinically palpable lymph node metastases. All patients underwent surgery and radiation to a median dose of 30 grays (Gy) at 6 Gy per fraction delivered twice weekly. Surgical resection was either a selective neck dissection in 90 patients or local excision of the lymph node metastasis in 35 patients. Only 35 patients underwent a radical, modified radical, or functional neck dissection. RESULTS At a median follow-up of 78 months, the actuarial local, regional, and locoregional control rates at 10 years were 94%, 94%, and 91%, respectively. Univariate analysis of patient, tumor, and treatment characteristics failed to reveal any association with the subsequent rate of local or regional control. The actuarial disease-specific (DSS), disease-free, and distant metastasis-free survival (DMFS) rates at 10 years were 48%, 42%, and 43%, respectively. Univariate and multivariate analyses revealed that patients with four or more involved lymph nodes had a significantly worse DSS and DMFS. Nine patients developed a treatment-related complication requiring medical management, resulting in a 5-year actuarial complication-free survival rate of 90%. CONCLUSIONS Adjuvant radiotherapy resulted in a 10-year regional control rate of 94%. Complications for all patients were rare and manageable when they did occur. The authors recommend adjuvant irradiation for patients with extracapsular extension, lymph nodes measuring 3 cm in size or larger, the involvement of multiple lymph nodes, recurrent disease, or any patient having undergone a selective therapeutic neck dissection. Cancer 2003;97:1789,96. © 2003 American Cancer Society. DOI 10.1002/cncr.11243 [source] Effectiveness of selective neck dissection in the treatment of the clinically positive neckHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2008FRCS ORL-HNS, Rajan S. Patel MBChB Abstract Background. The aim of this work was to determine whether or not patients treated with therapeutic selective neck dissection for head and neck squamous cell carcinoma were oncologically disadvantaged compared with those having comprehensive procedures. Methods. The study involves a retrospective review of 232 therapeutic neck dissections with a minimum of 2 years follow-up. Results. Patients having selective neck dissection had fewer adverse prognostic factors compared with patients having comprehensive dissection (pN2/3, p = .001; and extracapsular spread, p = .001). There were trends toward improved control in the dissected neck (96% vs 86%, p = .06), and disease-specific survival (59% vs 43%, p = .06) following selective neck dissection. Disease-specific survival for all patients was adversely affected by pN classification (p <.001) and extracapsular spread (p <.001). Conclusions. Patients undergoing aggressive neck surgery had more extensive disease. Selective neck dissection can be used to effectively treat clinically positive nodal disease in selected patients. © 2008 Wiley Periodicals, Inc. Head Neck 2008 [source] | ||||||||||