Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue

Bradley A. Schiff, Dianna B. Roberts, Adel El-Naggar, Adam S. Garden, Jeffrey N. Myers

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Abstract

Objectives: To assess the role of selective neck dissection in patients with squamous cell carcinoma (SCC) of the oral tongue with advanced nodal disease, and to assess the role of postoperative radiotherapy in patients with SCC of the oral tongue with pathologically N1 necks. Design: Retrospective study of the medical records of all patients who underwent neck dissection for SCC of the oral tongue from January 1, 1980, to December 31, 1995. Median follow-up was 5.7 years. Setting: The University of Texas M. D. Anderson Cancer Center, Houston, a tertiary care cancer hospital. Patients: A total of 220 patients with SCC of the oral tongue who received surgical treatment of both the primary tumor and the neck and who had an identifiable type of neck dissection, no synchronous or metachronous lesions, and no evidence of local recurrence. Interventions: All patients underwent resection of the primary tumor and neck dissection. The extent of neck dissection was determined by surgeon preference. Some patients received radiotherapy to the neck as well. Main Outcome Measures: Clinical and pathological nodal status,type of neck dissection, and use of radiotherapy. The end points evaluated included the regional control rates. Results: For clinically N+ patients, 5 of 45 treated with selective neck dissection and 1 of 19 treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck. If only patients with significant tumor burden on final pathological examination (clinically N+/pathologically N2) are considered, 4 (25.0%) of 16 patients undergoing selective neck dissection had recurrences in the neck, while none of the 14 patients treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck (P=.07). Of the 50 patients who had pathologically N1 disease, 25 received postoperative radiotherapy and 25 did not. Of the latter, 2 had recurrences in the neck, while none of the 25 patients who received radiotherapy had recurrences in the neck (P=.24). Conclusions: Selective neck dissection may be sufficient for many N+ patients with SCC of the oral tongue, but some patients with extensive nodal disease may benefit from more aggressive treatment of the neck. Radiotherapy may be beneficial for all of the node-positive patients, but further studies are needed. Prospective, randomized clinical trials will be useful in further defining the role of selective neck dissection in the clinically N2 neck and radiotherapy in the N1 neck for patients with SCC of the oral tongue.

Original languageEnglish (US)
Pages (from-to)874-878
Number of pages5
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume131
Issue number10
DOIs
StatePublished - Oct 2005

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Neck Dissection
Tongue
Squamous Cell Carcinoma
Radiotherapy
Observation
Neck
Therapeutics
Recurrence
Cancer Care Facilities
Neoplasms
Tertiary Healthcare

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue. / Schiff, Bradley A.; Roberts, Dianna B.; El-Naggar, Adel; Garden, Adam S.; Myers, Jeffrey N.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 131, No. 10, 10.2005, p. 874-878.

Research output: Contribution to journalArticle

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abstract = "Objectives: To assess the role of selective neck dissection in patients with squamous cell carcinoma (SCC) of the oral tongue with advanced nodal disease, and to assess the role of postoperative radiotherapy in patients with SCC of the oral tongue with pathologically N1 necks. Design: Retrospective study of the medical records of all patients who underwent neck dissection for SCC of the oral tongue from January 1, 1980, to December 31, 1995. Median follow-up was 5.7 years. Setting: The University of Texas M. D. Anderson Cancer Center, Houston, a tertiary care cancer hospital. Patients: A total of 220 patients with SCC of the oral tongue who received surgical treatment of both the primary tumor and the neck and who had an identifiable type of neck dissection, no synchronous or metachronous lesions, and no evidence of local recurrence. Interventions: All patients underwent resection of the primary tumor and neck dissection. The extent of neck dissection was determined by surgeon preference. Some patients received radiotherapy to the neck as well. Main Outcome Measures: Clinical and pathological nodal status,type of neck dissection, and use of radiotherapy. The end points evaluated included the regional control rates. Results: For clinically N+ patients, 5 of 45 treated with selective neck dissection and 1 of 19 treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck. If only patients with significant tumor burden on final pathological examination (clinically N+/pathologically N2) are considered, 4 (25.0{\%}) of 16 patients undergoing selective neck dissection had recurrences in the neck, while none of the 14 patients treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck (P=.07). Of the 50 patients who had pathologically N1 disease, 25 received postoperative radiotherapy and 25 did not. Of the latter, 2 had recurrences in the neck, while none of the 25 patients who received radiotherapy had recurrences in the neck (P=.24). Conclusions: Selective neck dissection may be sufficient for many N+ patients with SCC of the oral tongue, but some patients with extensive nodal disease may benefit from more aggressive treatment of the neck. Radiotherapy may be beneficial for all of the node-positive patients, but further studies are needed. Prospective, randomized clinical trials will be useful in further defining the role of selective neck dissection in the clinically N2 neck and radiotherapy in the N1 neck for patients with SCC of the oral tongue.",
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AU - Roberts, Dianna B.

AU - El-Naggar, Adel

AU - Garden, Adam S.

AU - Myers, Jeffrey N.

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N2 - Objectives: To assess the role of selective neck dissection in patients with squamous cell carcinoma (SCC) of the oral tongue with advanced nodal disease, and to assess the role of postoperative radiotherapy in patients with SCC of the oral tongue with pathologically N1 necks. Design: Retrospective study of the medical records of all patients who underwent neck dissection for SCC of the oral tongue from January 1, 1980, to December 31, 1995. Median follow-up was 5.7 years. Setting: The University of Texas M. D. Anderson Cancer Center, Houston, a tertiary care cancer hospital. Patients: A total of 220 patients with SCC of the oral tongue who received surgical treatment of both the primary tumor and the neck and who had an identifiable type of neck dissection, no synchronous or metachronous lesions, and no evidence of local recurrence. Interventions: All patients underwent resection of the primary tumor and neck dissection. The extent of neck dissection was determined by surgeon preference. Some patients received radiotherapy to the neck as well. Main Outcome Measures: Clinical and pathological nodal status,type of neck dissection, and use of radiotherapy. The end points evaluated included the regional control rates. Results: For clinically N+ patients, 5 of 45 treated with selective neck dissection and 1 of 19 treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck. If only patients with significant tumor burden on final pathological examination (clinically N+/pathologically N2) are considered, 4 (25.0%) of 16 patients undergoing selective neck dissection had recurrences in the neck, while none of the 14 patients treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck (P=.07). Of the 50 patients who had pathologically N1 disease, 25 received postoperative radiotherapy and 25 did not. Of the latter, 2 had recurrences in the neck, while none of the 25 patients who received radiotherapy had recurrences in the neck (P=.24). Conclusions: Selective neck dissection may be sufficient for many N+ patients with SCC of the oral tongue, but some patients with extensive nodal disease may benefit from more aggressive treatment of the neck. Radiotherapy may be beneficial for all of the node-positive patients, but further studies are needed. Prospective, randomized clinical trials will be useful in further defining the role of selective neck dissection in the clinically N2 neck and radiotherapy in the N1 neck for patients with SCC of the oral tongue.

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