Rodrigo Juan P, López-Álvarez Fernando, Medina Jesús E, Silver Carl E, Robbins K Thomas, Hamoir Marc, Mäkitie Antti, de Bree Remco, Takes Robert P, Golusinski Pawel, Kowalski Luiz P, Forastiere Arlene A, Homma Akihiro, Hanna Ehab Y, Rinaldo Alessandra, Ferlito Alfio
Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain.
Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain.
Eur J Surg Oncol. 2024 Jul;50(7):108389. doi: 10.1016/j.ejso.2024.108389. Epub 2024 May 4.
Concomitant chemoradiotherapy (CRT) is extensively used as primary organ preservation treatment for selected advanced laryngeal squamous cell carcinomas (LSCC). The oncologic outcomes of such regimens are comparable to those of total laryngectomy followed by adjuvant radiotherapy. However, the management of loco-regional recurrences after CRT remains a challenge, with salvage total laryngectomy being the only curative option. Furthermore, the decision whether to perform an elective neck dissection (END) in patients with rN0 necks, and the extent of the neck dissection in patients with rN + necks is still, a matter of debate. For rN0 patients, meta-analyses have reported occult metastasis rates ranging from 0 to 31 %, but no survival advantage for END. In addition, meta-analyses also showed a higher incidence of complications in patients who received an END. Therefore, END is not routinely recommended in addition to salvage laryngectomy. Although some evidence suggests a potential role of END for supraglottic and locally advanced cases, the decision to perform END should weigh benefits against potential complications. In rN + patients, several studies suggested that selective neck dissection (SND) is oncologically safe for patients with specific conditions: when lymph node metastases are not fixed and are absent at level IV or V. Super-selective neck dissection (SSND) may be an option when nodes are confined to one level. In conclusion, current evidence suggests that in rN0 necks routine END is not necessary and that in rN + necks with limited nodal recurrences SND or a SSND could be sufficient.
同步放化疗（CRT）被广泛用作特定晚期喉鳞状细胞癌（LSCC）的主要器官保留治疗方法。这种治疗方案的肿瘤学结果与全喉切除术后辅助放疗的结果相当。然而，CRT后局部区域复发的处理仍然是一个挑战，挽救性全喉切除术是唯一的治愈选择。此外，对于rN0颈部患者是否进行选择性颈清扫术（END）以及rN+颈部患者颈清扫术的范围仍存在争议。对于rN0患者，荟萃分析报告隐匿转移率为0%至31%，但END并无生存优势。此外，荟萃分析还显示接受END的患者并发症发生率更高。因此，除挽救性喉切除术外，不常规推荐END。尽管一些证据表明END对声门上型和局部晚期病例可能有作用，但决定是否进行END应权衡益处与潜在并发症。在rN+患者中，多项研究表明，对于特定情况的患者，选择性颈清扫术（SND）在肿瘤学上是安全的：当淋巴结转移不固定且IV或V区无转移时。当淋巴结局限于一个区域时，超选择性颈清扫术（SSND）可能是一种选择。总之，目前的证据表明，在rN0颈部，常规END没有必要，而在淋巴结复发有限的rN+颈部，SND或SSND可能就足够了。
