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Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

  • V Paleri (a1), T G Urbano (a2), H Mehanna (a3), C Repanos (a4), J Lancaster (a5), T Roques (a6), M Patel (a7) and M Sen (a8)...

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. A rational plan to manage the neck is necessary for all head and neck primaries. With the emergence of new level 1 evidence across several domains of neck metastases, this guideline will identify the evidence-based recommendations for management.

Recommendations

• Computed tomographic or magnetic resonance imaging is mandatory for staging neck disease, with choice of modality dependant on imaging modality used for the primary site, local availability and expertise. (R)

• Patients with a clinically N0 neck, with more than 15–20 per cent risk of occult nodal metastases, should be offered prophylactic treatment of the neck. (R)

• The treatment choice of for the N0 and N+ neck should be guided by the treatment to the primary site. (G)

• If observation is planned for the N0 neck, this should be supplemented by regular ultrasonograms to ensure early detection. (R)

• All patients with T1 and T2 oral cavity cancer and N0 neck should receive prophylactic neck treatment. (R)

• Selective neck dissection (SND) is as effective as modified radical neck dissection for controlling regional disease in N0 necks for all primary sites. (R)

• SND alone is adequate treatment for pN1 neck disease without adverse histological features. (R)

• Post-operative radiation for adverse histologic features following SND confers control rates comparable with more extensive procedures. (R)

• Adjuvant radiation following surgery for patients with adverse histological features improves regional control rates. (R)

• Post-operative chemoradiation improves regional control in patients with extracapsular spread and/or microscopically involved surgical margins. (R)

• Following chemoradiation therapy, complete responders who do not show evidence of active disease on co-registered positron emission tomography–computed tomography (PET–CT) scans performed at 10–12 weeks, do not need salvage neck dissection. (R)

• Salvage surgery should be considered for those with incomplete or equivocal response of nodal disease on PET–CT. (R)

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Address for correspondence: Vinidh Paleri, Department of Otolaryngology – Head and Neck Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Institute of Cancer Research, Newcastle upon Tyne, UK E-mail: vinidh.paleri@ncl.ac.uk

References

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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