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

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...

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Autores principales: Paleri, V, Urbano, T G, Mehanna, H, Repanos, C, Lancaster, J, Roques, T, Patel, M, Sen, M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873907/
https://www.ncbi.nlm.nih.gov/pubmed/27841133
http://dx.doi.org/10.1017/S002221511600058X
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author Paleri, V
Urbano, T G
Mehanna, H
Repanos, C
Lancaster, J
Roques, T
Patel, M
Sen, M
author_facet Paleri, V
Urbano, T G
Mehanna, H
Repanos, C
Lancaster, J
Roques, T
Patel, M
Sen, M
author_sort Paleri, V
collection PubMed
description 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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spelling pubmed-48739072016-05-27 Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines Paleri, V Urbano, T G Mehanna, H Repanos, C Lancaster, J Roques, T Patel, M Sen, M J Laryngol Otol Guidelines 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) Cambridge University Press 2016-05 /pmc/articles/PMC4873907/ /pubmed/27841133 http://dx.doi.org/10.1017/S002221511600058X Text en © JLO (1984) Limited 2016 http://creativecommons.org/licenses/by/4.0/ 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.
spellingShingle Guidelines
Paleri, V
Urbano, T G
Mehanna, H
Repanos, C
Lancaster, J
Roques, T
Patel, M
Sen, M
Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines
title Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines
title_full Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines
title_fullStr Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines
title_full_unstemmed Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines
title_short Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary Guidelines
title_sort management of neck metastases in head and neck cancer: united kingdom national multidisciplinary guidelines
topic Guidelines
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873907/
https://www.ncbi.nlm.nih.gov/pubmed/27841133
http://dx.doi.org/10.1017/S002221511600058X
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