Elective neck dissection in oral squamous cell carcinoma: Past, present and future Journal Article

Authors: de Bree, R.; Takes, R. P.; Shah, J. P.; Hamoir, M.; Kowalski, L. P.; Robbins, K. T.; Rodrigo, J. P.; Sanabria, A.; Medina, J. E.; Rinaldo, A.; Shaha, A. R.; Silver, C.; Suárez, C.; Bernal-Sprekelsen, M.; Ferlito, A.
Article Title: Elective neck dissection in oral squamous cell carcinoma: Past, present and future
Abstract: In 1994 a decision analysis, based on the literature and utility ratings for outcome by a panel of experienced head and neck physicians, was presented which showed a threshold probability of occult metastases of 20% to recommend elective treatment of the neck. It was stated that recommendations for the management of the cN0 neck are not immutable and should be reconfigured to determine the optimal management based on different sets of underlying assumptions. Although much has changed and is published in the almost 25 years after its publication, up to date this figure is still mentioned in the context of decisions on treatment of the clinically negative (cN0) neck. Therefore, we critically reviewed the developments in diagnostics and therapy and modeling approaches in the context of decisions on treatment of the cN0 neck. However, the results of studies on treatment of the cN0 neck cannot be translated to other settings due to significant differences in relevant variables such as population, culture, diagnostic work-up, follow-up, costs, institutional preferences and other factors. Moreover, patients may have personal preferences and may weigh oncologic outcomes versus morbidity and quality of life differently. Therefore, instead of trying to establish “the” best strategy for the cN0 neck or “the” optimal cut-off point for elective neck treatment, the approach to optimize the management of the cN0 neck would be to develop and implement models and decision support systems that can serve to optimize choices depending on individual, institutional, population and other relevant variables. © 2019 The Authors
Keywords: decision analysis; oral cancer; elective neck dissection
Journal Title: Oral Oncology
Volume: 90
ISSN: 1368-8375
Publisher: Elsevier Inc.  
Date Published: 2019-03-01
Start Page: 87
End Page: 93
Language: English
DOI: 10.1016/j.oraloncology.2019.01.016
PROVIDER: scopus
PUBMED: 30846183
Notes: Source: Scopus
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MSK Authors
  1. Ashok R Shaha
    552 Shaha
  2. Jatin P Shah
    565 Shah