The Laboratory for Applied Cancer Research Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Head Neck. 2013 Oct;35(10):1392-6. doi: 10.1002/hed.23145. Epub 2012 Sep 28.
We investigated the risk of neck metastases in patients undergoing salvage total laryngectomy in association with previous radiotherapy.
The medical records of 42 patients (51 neck specimens) with clinical N0 classification who underwent salvage total laryngectomy in 2 cancer centers were reviewed. Fourteen patients had previous radiotherapy to the central neck and 28 to the central and lateral neck.
Staging before salvage total laryngectomy was similar in both groups. The risk of neck metastases in the central and central/lateral radiation groups was 12% and 18%, respectively (p = .69). Subgroup analysis revealed that 4 of 8 patients initially presenting with clinically N+ had neck metastases before surgery, versus 2 of 26 for those with clinically N0 (p = .015; relative risk [RR] = 4.67). The risk or metastases in the contralateral neck was 0 of 9.
The risk of neck metastases in patients who undergo either central or central/lateral neck radiotherapy is similar. Elective neck dissection seems appropriate in patients undergoing SLR.
我们研究了既往接受过放射治疗的患者行挽救性全喉切除术时发生颈部转移的风险。
回顾了在 2 家癌症中心行挽救性全喉切除术的 42 例（51 个颈部标本）临床 N0 分类患者的病历资料。14 例患者曾接受过中央颈部放疗，28 例患者曾接受过中央和侧颈部放疗。
挽救性全喉切除术之前的分期在两组中相似。中央和中央/侧部放疗组的颈部转移风险分别为 12%和 18%（p =.69）。亚组分析显示，8 例最初表现为临床 N+的患者中有 4 例术前发生了颈部转移，而 26 例临床 N0 的患者中仅有 2 例（p =.015；相对风险 [RR] = 4.67）。对侧颈部转移的风险为 0 例。
行中央或中央/侧颈部放疗的患者发生颈部转移的风险相似。行 SLR 的患者行选择性颈部清扫术似乎是合适的。
