Robbins K Thomas, Shannon Kerwin, Vieira Francisco
Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9677, USA.
Arch Otolaryngol Head Neck Surg. 2007 May;133(5):486-9. doi: 10.1001/archotol.133.5.486.
To determine whether superselective neck dissection (removal of 2 or less contiguous neck levels) is effective salvage surgery for patients with residual single-level adenopathy after concomitant intra-arterial cisplatin and radiotherapy.
Analysis of prospectively collected data.
The study group comprised 177 patients (239 heminecks) with N+ disease.
Intra-arterial treatment with cisplatin (150 mg/m2) on days 1, 8, 15, and 22 and radiation therapy (2 Gy/d) 5 times per week for 7 weeks. Comparisons were made between neck-level-specific disease at restaging and pathologic disease after neck dissection.
Tumor sites included oropharynx (n = 81), hypopharynx (39), larynx (n=27), oral cavity (n = 19), and other (n = 11). Response of nodal disease based on clinical evaluation was as follows: complete response, 89 patients (50%); partial response, 81 patients (46%); progressive disease, 4 patients (2%); and unevaluable, 3 patients (2%). Of the 89 patients whose necks were restaged as a partial response, 73 had clinical evidence of residual adenopathy involving only 1 neck level. Within this subset, 54 patients (57 heminecks) subsequently underwent a salvage neck dissection, for which comparisons were made between the restaging evidence of residual adenopathy and the pathologic findings that were specific for each neck level. Only 2 of the 54 patients had evidence of pathologic disease extending beyond the single neck level: one had disease in a contiguous neck level, and the other had disease in a noncontiguous level. The use of superselective neck dissection with removal of only 2 contiguous neck levels would have encompassed known disease in all but 1 patient.
Superselective neck dissection is feasible after this specific chemoradiation protocol has been administered to patients with persistent nodal disease that is confined to 1 level.
确定超选择性颈部清扫术（切除2个或更少相邻颈部区域）对于接受顺铂动脉内注射联合放疗后残留单区域淋巴结病患者是否为有效的挽救性手术。
对前瞻性收集的数据进行分析。
研究组包括177例N+疾病患者（239个半侧颈部）。
在第1、8、15和22天进行顺铂动脉内治疗（150mg/m²），并每周5次，每次2Gy进行7周的放射治疗。对再次分期时颈部区域特异性疾病与颈部清扫术后的病理疾病进行比较。
肿瘤部位包括口咽（n = 81）、下咽（39）、喉（n = 27）、口腔（n = 19）和其他（n = 11）。基于临床评估的淋巴结疾病反应如下：完全缓解89例（50%）；部分缓解81例（46%）；疾病进展4例（2%）；不可评估3例（2%）。在89例颈部再次分期为部分缓解的患者中，73例有临床证据表明残留淋巴结病仅累及1个颈部区域。在这个亚组中，54例患者（57个半侧颈部）随后接受了挽救性颈部清扫术，并对残留淋巴结病的再次分期证据与每个颈部区域的病理结果进行了比较。54例患者中只有2例有病理疾病超出单个颈部区域的证据：1例在相邻颈部区域有疾病，另1例在非相邻区域有疾病。采用仅切除2个相邻颈部区域的超选择性颈部清扫术，除1例患者外，可涵盖所有已知疾病。
对局限于1个区域的持续性淋巴结病患者实施这种特定的放化疗方案后，超选择性颈部清扫术是可行的。
