Rola adjuwantowego usuwania układu chłonnego szyi po radiochemioterapii w zaawansowanym raku płaskonabłonkowym głowy i szyi – przegląd literatury

Chemoradiation (CT-RT) is currently a recognised standard of treatment for advanced squamous cell carcinoma of the head and neck. An adjuvant neck node dissection remains a controversial issue. Some authors suggest that surgery should be proposed for all patients with advanced N-stage at diagnosis regardless of the response to organ-preservation protocol which is CT-RT. Others recommend that the decision on surgery should be based on the clinical assessment of the response to radical CT-RT. Both strategies are characterised by a comparable regional control and progression free survival rates. They differ, however, in the quantity and quality of induced complications, and generate different costs. Therefore, an intensive search for (clinical or radiological) predictors to treatment response is needed to identify a specific group of patients who would benefit from adding neck dissection and without exposing complete responders to unnecessary complications. In this respect, the use of PET-CT scanning has gained some interest in selecting patients appropriate for lymphatic surgery. This method, however, has been found to have some faults and limitations.