Selective versus comprehensive neck dissection after chemoradiation for advanced oropharyngeal squamous cell carcinoma
Selective versus comprehensive neck dissection after chemoradiation for advanced oropharyngeal squamous cell carcinoma
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DOI：
10.1016/j.otohns.2009.09.010
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发表时间：
2009-12-01
影响因子：
3.4
通讯作者：
Ha, Patrick K.
中科院分区：
文献类型：
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作者：
Hillel, Alexander T.;Fakhry, Carole;Ha, Patrick K.
目的：为了确定晚期口咽鳞状细胞癌（OPSCC）患者在初次放化疗（CRT）后计划进行全面颈清扫术（CND）或选择性颈清扫术（SND）的适应证。研究设计：病例系列与图表回顾。地点：社区教学医院。受试者：在大巴尔的摩医学中心（GBMC）接受统一CRT方案的晚期OPSCC患者。方法：我们回顾了2001年至2007年在GBMC接受局部晚期OPSCC初次CRT治疗的患者的病历。所有患者分别接受7000至7500、6000和5000 cGy的原发病部位、累及宫颈和未累及宫颈及锁骨上淋巴管，同时接受顺铂治疗（12 mg/m（2）/l h）和5-氟尿嘧啶600 mg/m2/20 h，第1 ~ 5 d，第29 ~ 33 d。结果：76例患者接受CRT治疗，41例符合颈淋巴结清扫术标准。进行了48例颈清扫术（34例单侧和7例双侧），其中23例（48%）为CND，25例（52%）为SND。残留癌被发现在六（26%）的CND和五（20%）的SND半脑缺血。CND组有6例（26%）并发症，而SND组有2例（8%.CONCLUSION：本研究中显示的高残留疾病率支持CRT后颈淋巴结清扫术的必要性。虽然两组的并发症发生率没有显著差异，但本研究的趋势表明SND导致的发病率较低。假定的发病率降低和相同的区域控制率表明SND是OPSCC患者初次CRT后的适当手术选择。(C)2009年美国耳鼻咽喉头颈外科学会基金会。All rights reserved.
OBJECTIVE: To determine whether a comprehensive neck dissection (CND) or a selective neck dissection (SND) is indicated as planned post-primary chemoradiation treatment (CRT) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).STUDY DESIGN: Case series with chart review.SETTING: A community teaching hospital.SUBJECTS: Patients with advanced OPSCC who received a uniform CRT protocol at Greater Baltimore Medical Center (GBMC).METHODS: Medical records of patients treated with primary CRT for locoregionally advanced OPSCC at GBMC between 2001 and 2007 were reviewed. All patients received 7000 to 7500, 6000, and 5000 cGy to primary disease sites, involved cervical lymphatics, and uninvolved cervical and supraclavicular lymphatics, respectively, with concomitant cisplatin (12 mg/m(2)/l h) and 5-fluorouracil (600 mg/m(2)/20 h) given on days one through five and 29 through 33.RESULTS: Seventy-six patients received CRT, and 41 met the criteria for neck dissection. Forty-eight neck dissections were performed (34 unilateral and 7 bilateral), of which 23 (48%) were CNDs and 25 (52%) were SNDs. Residual carcinoma was found in six (26%) of the CND and five (20%) of the SND heminecks. The CND group had six (26%) complications, whereas the SND group had two (8%).CONCLUSION: The high rate of residual disease demonstrated in this study supports the need for post-CRT neck dissection. Although complication rates were not significantly different between the two groups, the trend in this study indicates that SND results in less morbidity. The presumed reduced morbidity and equivalent regional control rate suggest that SND is an appropriate surgical option for OPSCC patients after primary CRT. (C) 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.