Bar Ad Voichita, Chalian Ara
Department of Radiation Oncology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Oral Oncol. 2008 Sep;44(9):817-22. doi: 10.1016/j.oraloncology.2007.12.003. Epub 2008 Mar 6.
Management of the cervical metastases is of paramount importance in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). Head and neck oncologists continue to debate the appropriate approach of the clinically negative neck among patients with HNSCC. There are three management options: (A) Observation, reserving therapeutic neck dissection for only those patients who subsequently develop metastatic disease in the neck. (B) Staging with reserving definitive treatment for those who are found to have subclinical disease in the neck. Staging may require the use of imaging techniques or "staging" neck dissection. In the latter case a selective neck dissection (SND) is usually recommended, but it is still controversial if this surgical procedure for clinically negative neck is a staging or a therapeutic approach. (C) Elective treatment of the neck using neck dissection, radiation therapy or both. All these strategies may be appropriate, depending on the clinical circumstances and will be discussed in this review.
在头颈部鳞状细胞癌（HNSCC）患者的治疗中，颈部转移灶的处理至关重要。头颈部肿瘤学家对于HNSCC患者中临床阴性颈部的恰当处理方法仍存在争议。有三种处理方案：（A）观察，仅对那些随后出现颈部转移性疾病的患者进行治疗性颈清扫术。（B）分期，对那些被发现颈部有亚临床疾病的患者保留确定性治疗。分期可能需要使用影像学技术或“分期性”颈清扫术。在后一种情况下，通常推荐选择性颈清扫术（SND），但对于这种针对临床阴性颈部的手术是分期性还是治疗性方法仍存在争议。（C）使用颈清扫术、放射治疗或两者对颈部进行选择性治疗。所有这些策略可能都合适，具体取决于临床情况，本文将对此进行讨论。
