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|Title:||Elective lymphadenectomy during salvage for locally recurrent head and neck\ squamous cell carcinoma after radiation|
|Authors:||Prendes, B L;Aubin-Pouliot, A;Egbert, N;Ryan, W R|
|Keywords:||Adult;Age Factors;Aged;Carcinoma, Squamous Cell/*radiotherapy/secondary;Cohort Studies;Disease-Free Survival;Elective Surgical Procedures/*methods/mortality;Female;Head and Neck Neoplasms/pathology/*radiotherapy;Human;Lymph Node Excision/*methods;Lymph Nodes/pathology/surgery;Lymphatic Metastasis;Male;Middle Aged;Neck Dissection/methods;Neoplasm Invasiveness/pathology;Neoplasm Recurrence, Local/mortality/pathology/*su;Neoplasm Staging;Retrospective Studies;Risk Assessment;Salvage Therapy/methods/*mortality;Sex Factors;Survival Analysis;cervical lymphadenectomy;elective;head and neck cancer;neck dissection;recurrent;salvage surgery;Squamous Cell Carcinoma|
|Abstract:||OBJECTIVE: This study aimed to assess the rate of occult metastases in patients\ with head and neck mucosal squamous cell carcinoma who have undergone therapeutic\ neck radiation, and then develop primary site recurrence, without clinical\ evidence of recurrent neck disease. STUDY DESIGN: Case series with chart review. \ SETTING: Tertiary care center. SUBJECTS AND METHODS: Head and neck mucosal\ squamous cell carcinoma patients with N+ necks treated with primary radiation who\ developed primary site recurrence with radiologically resolved neck\ lymphadenopathy, treated with salvage primary-site surgery with or without\ elective cervical lymphadenectomy (ECL). Main outcome measures were rate of\ occult nodal metastases, complication rates, and disease-free survival. RESULTS: \ Sixteen patients met inclusion criteria. Of 18 neck sides that underwent either\ ECL or observation for a mean follow-up of 26 months, 4 (22.2%) were found to\ have positive occult cervical metastases, all on the ipsilateral side of\ preradiation neck disease. Patients with advanced T-stage and/or free flap\ reconstruction were more likely to undergo cervical lymphadenectomy. Patients\ with persistent (as opposed to recurrent) primary site tumors had the highest\ rate of occult cervical metastases. CONCLUSION: The risk of occult nodal\ metastases of 22.2%, in this study, may be too high to justify routinely omitting\ elective cervical lymphadenectomy in this patient population. Lymphadenectomy\ should especially be considered in patients with persistent tumors, with advanced\ recurrent T-stage, and undergoing free flap reconstruction.\|
|More Information:||Volume : 151\Issue : 3\Start page : 462|
END PAGES : 7\
|Appears in Collections:||Otolaryngology - Head and Neck Surgery|
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|2014 OHNS Volume 151 Issue 3 September (17).pdf||137.5 kB||Adobe PDF|
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