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ENT-Journal Club

ENT-Journal Club. Need for Neck dissection after Radiochemotherapy? A study of the French GETTEC Group. Vedrine P;Thariat J;Hitier M; Kaminsky M; et al. Need for Neck dissection after Radiochemotherapy? A study of the French GETTEC Group.The Laryngoscope, Head and Neck, 2008;118(10);1775-1780.

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ENT-Journal Club

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  1. ENT-Journal Club Need for Neck dissection after Radiochemotherapy? A study of the French GETTEC Group Vedrine P;Thariat J;Hitier M; Kaminsky M; et al. Need for Neck dissection after Radiochemotherapy? A study of the French GETTEC Group.The Laryngoscope, Head and Neck, 2008;118(10);1775-1780 Birga Terlunen-Traboldt

  2. Study design • The study discusses the need for a neck dissection (ND) after a RCT for patients with unresectable cancer of the head and neck • The study involved 103 patients with a tumor of oropharynx/hypopharynx or larynx tumor stage III or IV • 7 patients have a stage of III and 96 of IV • All patients were treated between 1996 and 2002 and had an unresectable primary tumor with node positiv disease (in ultrasound or CT scan) and no distant metastases • Patient with distant metastases, induction therapy or without a complete response in the primary tumor after the RCT were excluded Birga Terlunen-Traboldt

  3. Intention of the study • It is the intention of the study to clarify if it is always necessary to perform a neck dissection after RCT when there are positive nodes before the treatment Birga Terlunen-Traboldt

  4. Node stage of the patients The node stage of the 103 patients was as follows • 14 had a N1 node stage, 69 a N2 and 20 a N3 • All of them were treated with a radiotherapy to a median total dose of 70 Gy (45-70Gy) in the nodes and 70 Gy in the primary tumor • A standard chemotherapy was included two to three cycles of platinum-based therapy with 5-FU Birga Terlunen-Traboldt

  5. Response and no Response • A mean time of 3 months after RCT the patient underwent a clinical examination and a CT-scan, afterwards the decision was taken if it is a matter of nodal response or no response • A complete clinical and radiological disappearance was observed in the neck by 63 of the 103 patients (61%) • 40 patients had a residual neck disease (39%) • 28 (70%) of them underwent a neck dissection, the remaining 30% got a wachtfull follow-up by scary nodes or were unresectable or medically unfit for surgery Birga Terlunen-Traboldt

  6. Performance of Neck dissection • ND was performed with a mean delay of 4.2 month after RCT • 14 of the 28 ND (50%) showed pathological evidence of viable tumor • 10 of the 14 showed extracapsular spread Birga Terlunen-Traboldt

  7. Complications • Complications of ND after RCT were recorded in 4/28 cases; no greater wound healing problems or severe infectious were reported • It might be possible that the complication rate by surgery after RCT increases after treatment • So what is the best time for ND? • The CT scan is done 3 months after RCT and the surgical window is after the acute dermatitis phase and before the onset of chronic post RCT-subcutaneous fibrogenesis Birga Terlunen-Traboldt

  8. Conclusions • Disease free survival and overall survival were similar between patients with a complete response in neck and no ND and patients with a neck dissection for residual neck disease in this study • The feature of this study is to decide a neck dissection not from the tumor or nodes stage but from the completed nodal response, so by completed nodal response no ND should be necessary Birga Terlunen-Traboldt

  9. Hypotheses • This way is widely accepted worldwide for N1 disease but highly debated for N2-N3 neck disease, even after complete response • The combined imaging of CT scan, ultrasound and PET-CT can increase the reliability of nodal response after RCT • They should have divided the response patients in two groups one get also a ND and the other no other treatment then you can see in the follow up if the ND group get less positive nodes in the future or not Birga Terlunen-Traboldt

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