Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Strahlenther.Onkol. Année : 2024

Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary

Florent Carsuzaa
  • Fonction : Auteur
Emilien Chabrillac
  • Fonction : Auteur
Pierre Yves Marcy
  • Fonction : Auteur
Hisham Mehanna
  • Fonction : Auteur

Résumé

Purpose: Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. Methods: A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. Results: Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. Conclusion: Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.
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Dates et versions

hal-04555829 , version 1 (23-04-2024)

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Florent Carsuzaa, Emilien Chabrillac, Pierre Yves Marcy, Hisham Mehanna, Juliette Thariat. Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary. Strahlenther.Onkol., 2024, ⟨10.1007/s00066-024-02228-4⟩. ⟨hal-04555829⟩
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