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OTORINOLARINGOLOGIA

A Journal on Otorhinolaryngology, Head and Neck Surgery,
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Otorinolaringologia 2009 September;59(3):195-202

language: English

Post-chemoradiotherapy selective neck dissection for advanced head and neck squamous cell cancer

Butler C. R., Ferguson M. S., Magill J. C., Clarke P. M., Nouraei S. A. R.

Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK


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Considerable variation exists in the treatment of advanced upper aerodigestive tract squamous cell carcinoma, with some proponents advocating surgery, whilst others considering the organ preservation to be pivotal and recommend concomitant chemoradiotherapy (CRT). The increasing popularity of CRT has raised the question of how to treat bulky nodal disease (N2-3). Two conflicting oncological strategies have evolved to deal with this interesting conundrum. On the one hand some clinicians have adopted a ‘watch and wait’ policy with the need for salvage neck dissection dictated by serial radiological assessment. On the other, a staged neck dissection can be performed preemptively in an attempt to remove any residual viable tumour. The authors review the evidence that exists for both treatment modalities and currently advocate that all patients who present with N2-3 disease should undergo a planned selective neck dissection within 12 weeks of primary CRT.

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