Brown Kimberly M, Lango Miriam, Ridge John A
Head and Neck Surgery Section, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Semin Oncol. 2008 Jun;35(3):229-35. doi: 10.1053/j.seminoncol.2008.03.006.
No method reliably detects residual low-volume nodal disease in a patient with a complete response (CR) to treatment. Control of the N0-1 neck is to be expected after CR; no treatment is needed. Positron emission tomography (PET) may improve patient selection, but neck dissection should still be performed for patients with good performance status and residual masses. Neck dissection reduces the incidence of regional recurrence, although the impact on survival is small. Whether the risk of tumor recurrence or the morbidity of neck dissection should be of greater concern for patients with N2-3 disease in CR is a matter of individual judgment. Combined modality therapy will control most nodal metastases (even for patients with advanced nodal disease). Neck dissection in patients presenting with bulky nodal disease who achieve a CR after combined modality therapy will diminish the regional recurrence rate by about 15%. Nowadays, patients with N3 disease and CR often still have residual neck tumor. Node dissection is to be advised. Neck dissection should still be considered an important treatment modality for patients who undergo combined modality therapy with advanced nodal disease, even if they have achieved a CR.
对于治疗后达到完全缓解（CR）的患者，尚无可靠方法能检测出残留的低容量淋巴结疾病。CR后预计N0-1颈部可得到控制，无需治疗。正电子发射断层扫描（PET）可能有助于改善患者选择，但对于身体状况良好且有残留肿块的患者仍应进行颈部清扫术。颈部清扫术可降低区域复发率，尽管对生存率的影响较小。对于CR的N2-3期疾病患者，肿瘤复发风险或颈部清扫术的发病率哪一个更值得关注，这是一个个人判断的问题。综合治疗可控制大多数淋巴结转移（即使是晚期淋巴结疾病患者）。接受综合治疗后达到CR的有巨大淋巴结疾病的患者，颈部清扫术可使区域复发率降低约15%。如今，N3期疾病且CR的患者颈部通常仍有残留肿瘤，建议进行淋巴结清扫术。对于接受晚期淋巴结疾病综合治疗的患者，即使他们已达到CR，颈部清扫术仍应被视为一种重要的治疗方式。
