Radiotherapeutic management of bulky cervical lymphadenopathy in squamous cell carcinoma of the head and neck: is postradiotherapy neck dissection necessary?

C R Johnson, L N Silverman, L B Clay, R Schmidt-Ullrich
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引用次数: 73

Abstract

Although traditional recommendations for the management of bulky cervical lymphadenopathy (AJCC categories N2-3) with definitive radiotherapy call for postradiotherapy neck dissection regardless of treatment response, recent data suggests that this policy can be modified on the basis of tumor regression rate. In a series of 130 patients with stage III-IV squamous cell carcinoma of the head and neck managed with a concomitant boost-accelerated hyperfractionated radiotherapy schedule, 81 cases had cervical lymphadenopathy at the time of referral. Patients were analyzed with respect to regional control outcomes for those having complete and incomplete clinical responses during the initial 3-month follow-up interval. The general management policy has been close observation of patients demonstrating complete clinical responses to radiation rather than postradiotherapy neck dissection. Failure patterns were examined in the 58 patients classified as complete responders. Failure occurred in the primary site in 16 (28%) of these patients, while isolated neck failure occurred in only 3 (5%). Neck recurrence rates for patients with maximum lymph node size < or = 3 cm vs. > 3 cm were not statistically different at 3-year follow-up (94% vs. 86%). Among the 23 incomplete clinical responders, 18 had incomplete neck responses. Five of these patients underwent salvage neck dissection; 4 remain clinically free of recurrence. The remaining 13 patients who either refused or were not eligible for salvage surgery ultimately succumbed with persistent loco-regional disease. The policy of observation after complete response to the radiotherapy schedule employed here was associated with a very low incidence of isolated neck failures and was safe and appropriate in patients who can be followed reliably. The prognosis for patients who failed to respond in the neck was poor except for those who underwent salvage surgery.

头颈部鳞状细胞癌伴颈淋巴肿大的放射治疗:放疗后是否有必要进行颈部清扫?
尽管传统的治疗建议(AJCC分类N2-3)对大体积颈部淋巴结病(AJCC分类N2-3)进行明确的放疗,要求放疗后进行颈部清扫,无论治疗效果如何,但最近的数据表明,这一政策可以根据肿瘤消退率进行修改。在130例III-IV期头颈部鳞状细胞癌患者的一系列研究中,采用了伴随的增强加速高分割放疗计划,其中81例在转诊时出现了颈部淋巴结病。在最初的3个月随访期间,对有完全和不完全临床反应的患者进行区域对照结果分析。一般的管理方针是密切观察对放疗有完全临床反应的患者,而不是放疗后进行颈部清扫。在58例完全应答者中检查失败模式。16例(28%)患者发生原发部位衰竭,3例(5%)患者发生孤立性颈部衰竭。在3年随访中,最大淋巴结大小<或= 3cm与> 3cm患者的颈部复发率无统计学差异(94%对86%)。在23例不完全临床应答者中,18例颈部不完全应答。其中5例患者行救助性颈部清扫术;4例临床无复发。其余13例拒绝或不符合挽救性手术条件的患者最终因持续的局部区域疾病而死亡。在对放疗方案完全反应后的观察策略与孤立性颈部衰竭的发生率非常低有关,并且对于可以可靠随访的患者来说是安全和适当的。除接受挽救性手术外,颈部治疗无效的患者预后较差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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