July 28, 2016
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Elective neck dissection reduces regional recurrence in node-negative oral tongue carcinoma

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Elective neck dissection reduced risk for regional node recurrence and improved disease-specific survival compared with management and observation among patients with early-stage squamous cell carcinoma of the oral tongue, according to results of a literature review.

However, elective neck dissection (END) failed to improve OS.

Some clinicians believe patients with clinically node-negative early-stage oral tongue carcinoma should undergo observation, whereas other clinicians believe occult nodal disease contributes to locoregional treatment failure.

“To date, all available preoperative assessments, including physical examination and various imaging modalities — such as CT, MRI, PET–CT, and ultrasonography — cannot replace the role of END as an accurate diagnostic procedure for staging of node-negative neck,” Sara Abu-Ghanem, MD, MMedSc, researcher in the department of otolaryngology-head and neck surgery and maxillofacial surgery at Tel-Aviv Sourasky Medical Center in Tel-Aviv, Israel, and colleagues wrote. “END may help in defining the status of the neck, removing undetectable metastases and determining the need for adjuvant therapy.”

Abu-Ghanem and colleagues conducted a systematic literature review to compare END with observation for patients with node-negative oral tongue squamous cell carcinoma. Researchers searched MEDLINE, Scopus, Google scholar and Cochrane databases for studies published between 1970 and 2015 that included the terms “squamous cell carcinoma,” “oral tongue,” “mobile tongue,” “T1,” “T2,” “early stage,” “elective neck dissection,” “no neck treatment,” “observation,” “wait and watch,” “node-negative neck” and “N0 neck.”

The search yielded 20 retrospective and three prospective randomized studies — representing 3,244 patients — that compared END with observation for early-stage oral tongue squamous cell carcinoma. Analysis was limited to articles that evaluated patients who had no history of lymph node metastasis to the neck and at least 6 months of follow-up.

The majority of the articles analyzed were retrospective and observational; therefore, researchers followed the guidelines for meta-analysis of observational studies.

Regional nodal recurrence, disease-specific survival and OS served as endpoints for the analysis.

Results of a random-effects model showed that END significantly reduced the risk for regional recurrence (OR = 0.32; 95% CI, 0.22-0.46).

Further, patients who underwent END compared with patients who underwent observation experienced improved disease-specific survival (HR = 0.49; 95% CI, 0.33-0.72). However, END did not significantly improve OS (HR = 0.71; 95% CI, 0.41-1.22).

Researchers acknowledged that the analysis was limited by the retrospective nature of the majority of the included studies, their relatively small sample sizes and the limited data for survival analyses.

“The preference and choice of one treatment strategy over another is influenced by the subclinical occult nodal metastasis rate, the regional recurrence rate, survival rates and the salvage rate after recurrence,” Abu-Ghanem and colleagues wrote. “Proponents of an END strategy believe that END allows correct staging for prognosis and determination of the need for adjuvant therapies. Moreover, removal of metastatic lymph nodes would potentially reduce the risk [for] recurrence.” – by Nick Andrews

Disclosure: The researchers report no relevant financial disclosures.