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Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

  • A Deganello (a1), G Meccariello (a1), B Bini (a1), F Paiar (a2), R Santoro (a1), G Mannelli (a1) and O Gallo (a1)...

Abstract

Objectives:

To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer.

Methods:

A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005.

Results:

Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive).

Conclusion:

Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

Copyright

COPYRIGHT: © JLO (1984) Limited 2014 

Corresponding author

Address for correspondence: Prof O Gallo, Academic Clinic of Otolaryngology-Head and Neck Surgery, University of Florence, Viale Morgagni, 85 50134 Firenze, Italy Fax: +39 0557947939 E-mail: oreste.gallo@unifi.it

References

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1Higgins, KM, Shah, MD, Ogaick, MJ, Enepekides, D. Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy. J Otolaryngol Head Neck Surg 2009;38:603–12
2Motamed, M, Laccourreye, O, Bradley, PJ. Salvage conservation laryngeal surgery after irradiation failure for early laryngeal cancer. Laryngoscope 2006;116:451–5
3Cellai, E, Frata, P, Magrini, SM, Paiar, F, Barca, R, Fondelli, S et al. Radical radiotherapy for early glottic cancer: Results in a series of 1087 patients from two Italian radiation oncology centers. I. The case of T1N0 disease. Int J Radiat Oncol Biol Phys 2005;63:1378–86
4Agra, IM, Ferlito, A, Takes, RP, Silver, CE, Olsen, KD, Stoeckli, SJ et al. Diagnosis and treatment of recurrent laryngeal cancer following initial nonsurgical therapy. Head Neck 2012;34:727–35
5Sher, DJ, Haddad, RI, Norris, CM Jr, Posner, MR, Wirth, LJ, Goguen, LA et al. Efficacy and toxicity of reirradiation using intensity-modulated radiotherapy for recurrent or second primary head and neck cancer. Cancer 2010;116:4761–8
6Yuen, AP, Wei, WI, Wong, SH. Critical appraisal of watchful waiting policy in the management of N0 neck of advanced laryngeal carcinoma. Arch Otolaryngol Head Neck Surg 1996;122:742–5
7Yao, M, Roebuck, JC, Holsinger, FC, Myers, JN. Elective neck dissection during salvage laryngectomy. Am J Otolaryngol 2005;26:388–92
8Deganello, A, Gallo, O, De Cesare, JM, Ninu, MB, Gitti, G, de' Campora, L et al. Supracricoid laryngectomy as salvage surgery for radiation therapy failure. Head Neck 2008;30:1064–71
9Zbären, P, Christe, A, Caversaccio, MD, Stauffer, E, Thoeny, HC. Pretherapeutic staging of recurrent laryngeal carcinoma: clinical findings and imaging studies compared with histopathology. Otolaryngol Head Neck Surg 2007;137:487–91
10Spiro, RH, Gallo, O, Shah, JP. Selective jugular node dissection in patients with squamous carcinoma of the larynx or pharynx. Am J Surg 1993;166:399–402
11Deganello, A, Gitti, G, Meccariello, G, Parrinello, G, Mannelli, G, Gallo, O. Effectiveness and pitfalls of elective neck dissection in N0 laryngeal cancer. Acta Otorhinolaryngol Ital 2011;31:216–21
12Gallo, O, Deganello, A, Scala, J, De Campora, E. Evolution of elective neck dissection in N0 laryngeal cancer. Acta Otorhinolaryngol Ital 2006;26:335–44
13Brouwer, J, de Bree, R, Comans, EF, Castelijns, JA, Hoekstra, OS, Leemans, CR. Positron emission tomography using [18F] fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior? Eur Arch Otorhinolaryngol 2004;261:479–83
14Phillips, MH, Smith, WS, Parvathaneni, U, Laramore, GE. Role of positron emission tomography in the treatment of occult disease in head-and-neck cancer: a modeling approach. Int J Radiat Oncol Biol Phys 2011;79:1089–95
15Trojanowska, A, Trojanowski, P, Bisdas, S, Staśkiewicz, G, Drop, A, Klatka, J et al. Squamous cell cancer of hypopharynx and larynx – evaluation of metastatic nodal disease based on computed tomography perfusion studies. Eur J Radiol 2012;81:1034–9
16Ferlito, A, Silver, CE, Rinaldo, A. Selective neck dissection (IIA, III): a rational replacement for complete functional neck dissection in patients with N0 supraglottic and glottic squamous carcinoma. Laryngoscope 2008;118:676–9
17Santoro, R, Franchi, A, Gallo, O, Burali, G, de' Campora, E. Nodal metastases at level IIb during neck dissection for head and neck cancer: clinical and pathologic evaluation. Head Neck 2008;30:1483–87
18Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti, A, eds. American Joint Committee on Cancer Staging Manual, 7th edn.New York: Springer, 2009
19Lacy, PD, Piccirillo, JF. Development of a new staging system for patients with recurrent laryngeal squamous cell carcinoma. Cancer 1998;83:910–7
20Leon, X, Lopez, M, Garcia, J, Viza, I, Gich, I, Quer, M. Recurrent laryngeal squamous cell carcinoma: rTNM versus composite laryngeal recurrence staging system. Proposal for a modification of the CLRSS to improve patient classification. Head Neck 2008;30:939–45
21Bohannon, IA, Desmond, RA, Clemons, L, Magnuson, JS, Carrol, WR, Rosenthal, EL. Management of the N0 neck in recurrent laryngeal squamous cell carcinoma. Laryngoscope 2010;120:58–61
22Wax, MK, Touma, BJ. Management of the N0 neck during salvage laryngectomy. Laryngoscope 1999;109:4–7
23Ganly, I, Patel, S, Matsuo, J, Singh, B, Kraus, D, Boyle, J et al. Postoperative complications of salvage total laryngectomy. Cancer 2005;103:2073–81
24Gallo, O, Deganello, A, Gitti, G, Santoro, R, Senesi, M, Scala, J et al. Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies. Oral Oncol 2009;45:30–8

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  • Cited by 7

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Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

  • A Deganello (a1), G Meccariello (a1), B Bini (a1), F Paiar (a2), R Santoro (a1), G Mannelli (a1) and O Gallo (a1)...

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