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The potential role of imaging techniques in avoiding neck dissection during salvage surgery after head and neck carcinoma treated with bioradiotherapy

Published online by Cambridge University Press:  06 September 2021

A Rovira ,
J Tornero ,
M Taberna ,
M Oliva ,
R Montal ,
J Nogues ,
A Mari ,
J M Viñals ,
A Lozano  and
M Maños
...Show all authors
A Rovira*
Affiliation:
Department of Otorhinolaryngology, Bellvitge University Hospital, Spain Faculty of Medicine, Catalan Institute of Oncology, Barcelona, Spain
J Tornero
Affiliation:
Department of Otorhinolaryngology, Bellvitge University Hospital, Spain
M Taberna
Affiliation:
Faculty of Medicine, Catalan Institute of Oncology, Barcelona, Spain Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain
M Oliva
Affiliation:
Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain
R Montal
Affiliation:
Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain
J Nogues
Affiliation:
Department of Otorhinolaryngology, Bellvitge University Hospital, Spain
A Mari
Affiliation:
Department of Maxillofacial Surgery, Bellvitge University Hospital, Spain
J M Viñals
Affiliation:
Department of Plastic and Reconstructive Surgery, Bellvitge University Hospital, Spain
A Lozano
Affiliation:
Department of Radiotherapy, Hospital Duran I Reynalds, Catalan Institute of Oncology, Barcelona,University of Barcelona, Spain
M Maños
Affiliation:
Department of Otorhinolaryngology, Bellvitge University Hospital, Spain Faculty of Medicine, Catalan Institute of Oncology, Barcelona, Spain
R Mesia
Affiliation:
Faculty of Medicine, Catalan Institute of Oncology, Barcelona, Spain Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain
*
Author for correspondence: Mr Aleix Rovira, ENT Department, Guy's Hospital, Great Maze Pond, LondonSE1 9RT, UK E-mail: aleix.rovira@nhs.net
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Abstract

Objective

This study aimed to evaluate the effectiveness of computed tomography and positron emission tomography-computed tomography prior to salvage surgery after head and neck carcinoma treated with bioradiotherapy and to look at the role of neck dissection in this setting.

Method

This study was a retrospective chart review of a series of consecutive patients with locally advanced head and neck squamous cell carcinoma treated with bioradiotherapy. Radiological and pathological stages were compared to evaluate the accuracy of computed tomography and positron emission tomography-computed tomography in detecting occult neck metastasis in the context of recurrence of primary tumour. In order to assess the impact of neck dissection on survival, Kaplan–Meier survival curves after salvage surgery with and without neck dissection were derived.

Results

A total of 268 patients were identified, of which 22 underwent salvage surgery. The negative predictive value of computed tomography and positron emission tomography-computed tomography was excellent. Neck dissection did not represent an improvement on overall, disease specific and regional recurrence free survival (p = 0.67, p = 0.91 and p = 0.62, respectively) amongst clinically and radiologically negative necks.

Conclusion

Conservative treatment of the neck should be considered when dealing with patients with primary site recurrence or persistent disease after bioradiotherapy without evidence of neck disease.

Keywords

CetuximabSquamous Cell Carcinoma Of Head And NeckNeck DissectionPositron Emission Tomography Computed TomographySalvage Therapy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 11 , November 2021 , pp. 970 - 975
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr A Rovira takes responsibility for the integrity of the content of the paper

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