Management of the Neck in the Setting of Definitive Chemoradiation: Is There a Consensus? A GETTEC Study

• Published in: Annals of surgical oncology Vol. 19; no. 7; pp. 2311 - 2319
• Main Authors: Thariat, Juliette, Hamoir, Marc, Garrel, Renaud, Cosmidis, Alain, Dassonville, Olivier, Janot, Righini, C. A., Vedrine, P. O., Prades, J. M., Lacau-Saint-Guily, J., Jegoux, F., Malard, O., De Mones, E., Benlyazid, A., Bensadoun, R.-J., Baujat, B., Merol, J. C., Ferron, C., Scavennec, C., Salvan, D., Mallet, Y., Moriniere, S., Vergez, S., Choussy, O., Dollivet, G., Guevara, N., Ceruse, P., De Raucourt, D., Lallemant, B., Lawson, G., Lindas, P., Poupart, M., Duflo, S., Dufour, Xavier
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2012; Springer Nature B.V
• Subjects: Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Combined Modality Therapy; Consensus; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Head and Neck Oncology; Humans; Induction Chemotherapy; Medicine; Medicine & Public Health; Neck Dissection; Oncology; Positron-Emission Tomography; Practice Patterns, Physicians' - standards; Prognosis; Radiotherapy Dosage; Surgery; Surgical Oncology; Tomography, X-Ray Computed; Induction Chemotherapy; Nodal Response; Human Papilloma Virus; Positron Emission Tomography; Neck Dissection
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2275-9

Background The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2–3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2–3 or selective ND for residual disease Methods We studied the patterns of care in the French-Belgian Groupe d’Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey. Results Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND. Conclusions Omission of ND based on computed tomographic scan and positron emission tomography–based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus–related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.