Department of Radiation Oncology at the University of Florida College of Medicine, Gainesville, FL, USA
Am J Otolaryngol. 2012 Mar-Apr;33(2):199-204. doi: 10.1016/j.amjoto.2011.04.009.
The aim of this study was to define the role of neck dissection during surgery for patients who have received elective nodal irradiation in the course of treatment for a prior squamous cell carcinoma of the head and neck (SCCHN) and are subsequently diagnosed with a second primary SCCHN.
We reviewed the medical records of 13 patients who received both definitive radiotherapy and elective nodal irradiation for T1-4 N0 M0 SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx who then subsequently developed a metachronous T1-4 N0 M0 SCCHN primary at a new site. All second primary tumors were treated with surgery. Ten of the 13 patients also received an elective neck dissection (END) at that time: 7 unilateral and 3 bilateral. We report the outcomes for the patients in this series.
One (8%) of 13 neck dissection specimens was positive in 1 (10%) of 10 patients. The 5-year outcomes were the following: local-regional control, 67%; local control, 77%; disease-free survival, 62%; overall survival, 38%; and cause-specific survival rate, 77%. Six patients experienced treatment-related complications of grade 2 or higher (per Common Terminology Criteria for Adverse Events, version 4). Complications occurred exclusively in patients who received an END.
The risk of occult nodal disease may be low enough to justify omitting an END for a second primary SCCHN in selected patients while maintaining treatment efficacy and reducing patient morbidity. Larger studies on this subject are needed to further address this question.
本研究旨在明确颈清扫术在治疗头颈部鳞状细胞癌（SCCHN）患者中的作用。这些患者在治疗过程中已接受选择性淋巴结照射，随后又被诊断出第二原发 SCCHN。
我们回顾了 13 例接受过口腔、口咽、下咽或喉 T1-4 N0 M0 SCCHN 根治性放疗和选择性淋巴结照射的患者的病历，这些患者随后在新部位出现了异时性 T1-4 N0 M0 SCCHN 原发性肿瘤。所有第二原发肿瘤均采用手术治疗。其中 13 例中有 10 例（10/13，77%）还同时进行了选择性颈清扫术（END）：7 例为单侧，3 例为双侧。我们报告了这一系列患者的结局。
10 例接受 END 的患者中，有 1 例（1/10，10%）的颈清扫标本阳性。该系列患者的 5 年结局如下：局部区域控制率为 67%，局部控制率为 77%，无病生存率为 62%，总生存率为 38%，特异性生存率为 77%。6 例患者发生了 2 级或以上的治疗相关并发症（根据常见不良事件术语标准，第 4 版）。这些并发症仅发生在接受 END 的患者中。
对于某些特定的患者，隐匿性淋巴结疾病的风险可能足够低，因此可以省略第二原发 SCCHN 的 END，同时保持治疗效果并降低患者的发病率。需要更大规模的研究来进一步解决这个问题。
