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Management of the Neck in the Setting of Definitive Chemoradiation: Is There a Consensus? A GETTEC Study

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2–3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2–3 or selective ND for residual disease

Methods

We studied the patterns of care in the French-Belgian Groupe d’Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey.

Results

Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND.

Conclusions

Omission of ND based on computed tomographic scan and positron emission tomography–based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus–related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.

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Conflict of interest

All GETTEC members participated in the questionnaire, have no financial disclosure, and agree for copyright transfer

Author information

Authors and Affiliations

  1. Department of Radiotherapy, Center Antoine-Lacassagne, IUFC, Nice, France

    Juliette Thariat MD

  2. St Luc University Hospital, Brussels, Belgium

    Marc Hamoir MD

  3. CHU, Montpellier, France

    Renaud Garrel MD, PhD

  4. CHU, Lyon, France

    Alain Cosmidis MD, P. Ceruse MD, PhD & M. Poupart MD

  5. CAL, Nice, France

    Olivier Dassonville MD

  6. Institute Gustave Roussy, Villejuif, France

    Janot MD

  7. CHU, Grenoble, France

    C. A. Righini MD, PhD

  8. CH, Cannes, France

    P. O. Vedrine MD

  9. CHU, St Etienne, France

    J. M. Prades MD

  10. CHU, Tenon, Paris, France

    J. Lacau-Saint-Guily MD

  11. CHU, Rennes, France

    F. Jegoux MD

  12. CHU, Nantes, France

    O. Malard MD, PhD, B. Baujat MD, PhD & C. Ferron MD

  13. CHU, Bordeaux, France

    E. De Mones MD

  14. Centre Claudius Regaud, Toulouse, France

    A. Benlyazid MD

  15. CHU, Poitiers, France

    R.-J. Bensadoun MD & Xavier Dufour MD, PhD

  16. CHU Beaujon, Paris, France

    B. Baujat MD, PhD

  17. CHU, Reims, France

    J. C. Merol MD

  18. CH, Draguignan, France

    C. Scavennec MD

  19. CH, Evry, France

    D. Salvan MD

  20. Centre Oscar Lambret, Lille, France

    Y. Mallet MD, PhD

  21. CHU, Tours, France

    S. Moriniere MD, PhD

  22. CHU, Toulouse, France

    S. Vergez MD, PhD

  23. CHU, Rouen, France

    O. Choussy MD, PhD

  24. CHU, Nancy, France

    G. Dollivet MD, PhD

  25. CHU-IUFC, Nice, France

    N. Guevara MD

  26. Centre Baclesse, Caen, France

    D. De Raucourt MD

  27. CHU, Nimes, France

    B. Lallemant MD, PhD

  28. CHU, Yvoir, Belgium

    G. Lawson MD, PhD

  29. CH, Metz, France

    P. Lindas MD

  30. CHU, Pointe-a-Pitre, Guadeloupe

    S. Duflo MD, PhD

Authors
  1. Juliette Thariat MD
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  2. Marc Hamoir MD
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  3. Renaud Garrel MD, PhD
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  4. Alain Cosmidis MD
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  6. Janot MD
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  7. C. A. Righini MD, PhD
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  8. P. O. Vedrine MD
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  9. J. M. Prades MD
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  10. J. Lacau-Saint-Guily MD
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  14. A. Benlyazid MD
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  15. R.-J. Bensadoun MD
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  16. B. Baujat MD, PhD
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  17. J. C. Merol MD
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  18. C. Ferron MD
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  29. B. Lallemant MD, PhD
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  30. G. Lawson MD, PhD
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  31. P. Lindas MD
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  32. M. Poupart MD
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  33. S. Duflo MD, PhD
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  34. Xavier Dufour MD, PhD
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Corresponding author

Correspondence to Juliette Thariat MD.

Additional information

This study was conducted on behalf of the Groupe d’Etude des Tumeurs de la Tete Et du Cou (GETTEC).

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Appendix

Groupe d’Etude des Tumeurs de la Tete Et du Cou

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Thariat, J., Hamoir, M., Garrel, R. et al. Management of the Neck in the Setting of Definitive Chemoradiation: Is There a Consensus? A GETTEC Study. Ann Surg Oncol 19, 2311–2319 (2012). https://doi.org/10.1245/s10434-012-2275-9

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