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10-04-2024 | Neck Dissection | Review Article

Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary

Authors: Dr. Florent Carsuzaa, MD, Dr. Emilien Chabrillac, MD, Dr. Pierre Yves Marcy, MD, Prof. Hisham Mehanna, MD PhD, Prof. Juliette Thariat, MD PhD

Published in: Strahlentherapie und Onkologie

Abstract

Purpose

Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy.

Methods

A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy.

Results

Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis.

Conclusion

Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.

Graphic abstract

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Title: Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary
Authors: Dr. Florent Carsuzaa, MD
Dr. Emilien Chabrillac, MD
Dr. Pierre Yves Marcy, MD
Prof. Hisham Mehanna, MD PhD
Prof. Juliette Thariat, MD PhD
Publication date: 10-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Neck Dissection
Radiotherapy
Cytostatic Therapy
Published in: Strahlentherapie und Onkologie
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-024-02228-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary

Abstract

Purpose

Methods

Results

Conclusion

Graphic abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Graphic abstract

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