Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
Head Neck. 2012 Jan;34(1):113-9. doi: 10.1002/hed.21599. Epub 2010 Nov 10.
Up-front surgery and postoperative radiotherapy constitute a well-recognized treatment concept for locally or regionally advanced squamous cell carcinoma of the head and neck. This "treatment package" is further intensified with the concomitant application of chemotherapy during irradiation when high-risk features (ie, microscopically involved resection margins, extracapsular extension of the tumor from neck nodes, the presence of soft tissue deposits) are found on histopathologic examination of a resected specimen. With regard to neck disease, however, the demarcation line between low- and higher-risk clinical situations, which would differ with respect to the need for postoperative radiotherapy, is not clear. In an attempt to define the low-risk characteristics of disease in the neck that do not require adjuvant irradiation, we reviewed the available literature reports for any direct or indirect evidence on the value of postoperative radiotherapy in various clinical scenarios. The number of positive lymph nodes found in a dissected tissue specimen that should be used as a "cut-off" point for introduction of postoperative radiotherapy was evaluated in the context of both primary tumor characteristics and type of neck dissection.
upfront 手术和术后放疗是局部或区域性晚期头颈部鳞状细胞癌的公认治疗方案。当在切除标本的组织病理学检查中发现高风险特征（即显微镜下累及切缘、肿瘤从颈部淋巴结包膜外延伸、软组织沉积）时，通过在放疗期间同时应用化疗，这种“治疗方案”得到了进一步加强。然而，对于颈部疾病，需要术后放疗的低风险和高风险临床情况之间的界限并不明确。为了确定颈部疾病中不需要辅助放疗的低风险特征，我们回顾了现有文献报告，以寻找有关术后放疗在各种临床情况下价值的直接或间接证据。在原发性肿瘤特征和颈部解剖类型的背景下，评估了在切除组织标本中发现的阳性淋巴结数量，作为引入术后放疗的“截止”点。
