Abstract
Objective: Neck management in cT1-2N0 tongue squamous cell carcinoma (SCC) remains controversial. Our goal was to compare the survival difference between PET-CT–guided neck dissection and elective neck dissection (END) for the treatment of cT1-2 tongue SCC.Methods: Patients with surgically treated cT1-2N0 tongue SCC were retrospectively enrolled. These patients were divided into two groups. Group A: The decision of whether to perform neck dissection was mainly based on the results of preoperative PET-CT examinations. Group B: Patients received END treatment without preoperative PET-CT examinations. The study endpoints were regional control (RC) and disease-specific survival (DSS). The Kaplan–Meier method was used to calculate the survival rates.Results: Group A consisted of 66 patients, and 16 patients underwent neck dissection owing to positive PET-CT results. Group B consisted of 169 patients. The 5-year RC rates in group A and group B were 86 and 87%, respectively, and the difference was not significant (p = 0.731). The 5-year DSS rates in group A and group B were 93 and 90%, respectively, and the difference was not significant (p = 0.583).Conclusions: Neck dissection can be safely avoided when the PET-CT scan reveals no neck lymph node involvement.
Highlights
Tongue squamous cell carcinoma (SCC) is the most common malignancy in the oral cavity, and surgery is usually the first choice of treatment
Current high-quality research has described that routine neck dissection improves the prognosis by distinguishing patients who need adjuvant radiotherapy [1, 4, 5], researchers argue that most patients with cT1-2N0 disease do not have pathologic lymph node metastasis, and they are over-treated and exposed to possible neck dissection–related complications [2, 3]; more importantly, the survival benefit associated with routine neck dissection could be contributed to by the late treatment of the metastatic necks at initial treatment
Seven had a pathologic N+ neck at the initial treatment, two patients had not previously received neck dissection owing to previous negative PET-CT results, there was no local recurrence or distant metastasis, the 5-year regional control (RC) rate was 86%, recurrent disease was successfully salvaged in six patients with radical operations, four patients died of the disease, and the 5-year disease-specific survival (DSS) rate was 93%
Summary
Patients with surgically treated cT1-2N0 tongue SCC were retrospectively enrolled. These patients were divided into two groups. Group A: The decision of whether to perform neck dissection was mainly based on the results of preoperative PET-CT examinations. Group B: Patients received END treatment without preoperative PET-CT examinations. The study endpoints were regional control (RC) and disease-specific survival (DSS). The Kaplan–Meier method was used to calculate the survival rates
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