Sanabria Alvaro, Silver Carl E, Olsen Kerry D, Medina Jesus E, Hamoir Marc, Paleri Vinidh, Mondin Vanni, Rinaldo Alessandra, Rodrigo Juan P, Suárez Carlos, Boedeker Carsten C, Hinni Michael L, Kowalski Luiz P, Teymoortash Afshin, Werner Jochen A, Takes Robert P, Ferlito Alfio
Department of Surgery, Universidad de Antioquia, Hospital Pablo Tobón Uribe, Medellín, Colombia.
Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3111-9. doi: 10.1007/s00405-014-2893-x. Epub 2014 Feb 11.
Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields.
在最初接受（化疗）放疗的颈部阴性的头颈部鳞状细胞癌患者中，有一些病例会出现局部复发而无明显颈部复发。关于这些病例中颈部最有效的处理方法，几乎没有可用信息。我们回顾了文献，看看能从以前的报告中得出什么结论。我们在MEDLINE和EMBASE数据库上进行了文献检索。纳入了以英文发表的研究以及关于口腔、鼻咽、口咽、喉和下咽鳞状细胞癌的研究。从文章中提取了与颈部处理相关的数据。十二项研究符合纳入标准。五项研究仅报告了一种治疗方案（要么是颈部清扫术，要么是观察），而其他研究则比较了颈部清扫术与观察。隐匿性转移率在3.4%至12%之间。这些研究包括复发性原发肿瘤的原发部位和分期的不同分布。临床rN0患者隐匿性颈部淋巴结转移的风险与肿瘤部位和T分期相关。对于T1-2声门肿瘤且复发肿瘤进展较轻（rT1-2）的患者，可以建议观察颈部。对于喉复发更严重或在其他高危部位复发的患者，对于rN0患者可考虑行颈部清扫术，特别是如果颈部未包括在先前的放疗野内。
