Aims: In patients with squamous cell carcinoma of head and neck, optimum management of neck is always controversial. SOHND has assumed increasing importance as a staging procedure in patients with NO necks as well as a potentially curative procedure in selected patients with limited metastatic disease in neck. Methods: Between 1994 to 1999, 246 patients underwent neck dissection for squamous cell carcinoma of oral cavity at Cancer Hospital and Research Institute, Gwalior, India. The mean age of these patients was 56 years. One-hundred and ninety-seven (80.08%) were male and 49 (19.9%) were female. Stage distribution (UICC) was as follows: stage I 16 (7%), stage II 82 (34%), stage III 89 (36%), stage IV 59 (24%). In all cases, primary disease was treated by surgical excision. SOHND was done in NO and limited N + neck and RND was done in NO, N1, N2 and N3 patients. All these pathologically N+ cases and patients with large primaries were subjected to adjuvant RT. Results: After SOHND, 71 (78%) cases were pathologically NO and 20 (22%) were pathologically N + . At the end of 3 years, 80% of them were free of disease and 20% of N + developed nodal recurrence. One-hundred and ninety-seven patients were treated by excision of primary and RND. LN were positive in 105 (53%) and 92 (47%) were histopathologically negative. Out of 197, 114 (58%) patients received radiotherapy whereas 54 (27%) did not receive radiotherapy. Of these 197, 19 (10%) patients developed recurrences at the primary site, 31 (16%) developed nodal recurrence, 8 (4.0%) developed recurrence in the opposite neck and 3 (2%) developed distant metastasis. At the end of 3-years follow-up, 58% survival was observed in those who underwent RND and RT with 36% survival for those who were treated by RND without RT. The majority of nodal recurrence occurred in first 18 months. In the pN+ group recurrence occurred in 52 (21%) whereas 26 (11 %) were found in the pNO necks. Conclusion: We conclude that occult nodal metastasis was present in 12% of necks that have undergone an elective SOHND. This suggests that SOHND adequately sample the areas of potential LN involvement in most oral cancer patients. The treatment failure rate was also less than 10% by SOHND as reported in other studies. In patients who underwent RND without RT the nodal recurrence was higher. Addition of RT to ND decreases nodal recurrence in neck and increases the disease free survival. Involvement of multiple LN at different levels and presence of extracapsular spread worsens survival.
|Original language||English (US)|
|Issue number||SUPPL. 1|
|State||Published - Dec 1 2001|
ASJC Scopus subject areas
- Oral Surgery
- Cancer Research