Management of the Neck in HNSCC: Controversies and Guidelines in 2011

Abstract

Program Description: Neck dissection continues to be an integral part of surgical treatment of head and neck squamous cell carcinoma (HNSCC). The operation has evolved significantly since first described by Crile and others more than 100 years ago. With the development of more precise imaging modalities, chemoradiation treatment protocols, and transoral laser (TLM) and robotic (TORS) surgery, it is important to reexamine guidelines for management of the neck. This miniseminar will focus on several relevant topics pertaining to treatment of the neck in HNSCC: 1) The role of imaging in planning treatment of the neck will be discussed. Pre-treatment imaging with PET, CT, and MRI can yield valuable information regarding subclinical neck metastases and may help in treatment planning, particularly for T1 and T2 primary tumors. The timing and optimal modality for post-chemoradiation imaging remains controversial. 2) The advantages and disadvantages for upfront neck dissection for small and unknown primary HNSCC will be addressed. Elective neck dissection vs radiation vs observation for clinically negative necks will be discussed. 3) Management of the neck in conjunction with TLM/TORS will be examined. With increasing use of TLM/TORS for surgical management of HNSCC, it is essential that the neck is treated appropriately. Guidelines for neck dissection in conjunction with TLM/TORS will be outlined. 4) Paradigms for management of the neck following chemoradiation continue to evolve. Chemoradiation protocols for HNSCC are effective in eradicating advanced nodal disease as well as the primary tumor. Thus, the use of planned neck dissection for N2 and N3 disease following completion of chemoradiation is giving way to the use of salvage neck dissection. Also, concepts have changed toward the use of more limited neck dissections. Finally, challenging cases involving management of neck disease will be presented to the panel of experts, for discussion and audience participation. Educational Objectives: 1) Understand the role of imaging in planning treatment of the neck. 2) Understand how to manage the neck in conjunction with TLM/TORS. 3) Understand how paradigms for management of the neck following chemoradiation have evolved.