Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, SAR, China.
Curr Oncol Rep. 2013 Apr;15(2):142-5. doi: 10.1007/s11912-013-0294-8.
The status of the regional cervical lymphatics is one of the most significant prognostic indicators in head and neck cancers. The traditional treatment for cancers with cervical nodal metastasis has been surgical. With the global trend towards organ-preserving therapy, chemoradiation has gained increasing popularity over primary surgical therapies for cancers in the head and neck region. The subsequent management of the neck for those with residual or recurrent nodal metastasis, however, has become one of the most debated topics in the field of head and neck oncology. This review addressed several important controversies, including the optimal assessment of the nodal response to chemoradiation, the potential role and the oncological results of planned and salvage neck dissection after chemoradiation, as well as the type and extent of neck dissection required in order to achieve the optimal balance between tumour control and surgical morbidities. Further clinical trials and on-going research will help us to define the best therapeutic option in such circumstances.
区域颈部淋巴结状态是头颈部癌症最重要的预后指标之一。对于颈部淋巴结转移的癌症，传统的治疗方法一直是手术。随着全球向保留器官治疗的趋势发展，放化疗对头颈部癌症的治疗越来越受欢迎，而对于那些残留或复发的淋巴结转移的患者，颈部的后续管理已成为头颈部肿瘤学领域最具争议的话题之一。本文综述了几个重要的争议，包括评估放化疗后淋巴结反应的最佳方法、放化疗后计划和挽救性颈部清扫术的潜在作用和肿瘤学结果，以及为了在肿瘤控制和手术并发症之间取得最佳平衡，所需的颈部清扫术的类型和范围。进一步的临床试验和正在进行的研究将有助于我们确定在这种情况下的最佳治疗选择。
