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who underwent observation of the contralateral neck The location of the primary tumor plays an important role
and those who underwent contralateral END, even when in other studies. The carcinoma of the base of tongue
those in the observation group who received radiation seems to have a high propensity to produce bilateral neck
[23]
therapy were excluded. metastases. For Olzowy et al., in the case of involvement
of the base of tongue, the neck should be operated on
Although the reason for these findings is unclear, it has bilaterally, independent of T classification of the primary.
been suggested that END, in conjunction with primary In carcinomas of the soft palate greater than T1, bilateral
tumor resection, may predispose patients to aberrant neck dissection should also be recommended because of
[38]
migration of intransit carcinomatous cells to the a high frequency of bilateral metastases. For Lin et al.,
opposite side of the neck. Chow et al. failed to show prophylactic CND is suggested for primary oral tumors
[12]
[28]
bilateral neck dissections reduced the contralateral neck with mouth floor invasion or midline crossing, or at
relapse by statistical testing. Remarkably, only 1 of the 12 advanced tumor stage (> T3). This recommendation is
patients undergoing bilateral neck dissection as part of not supported by most authors.
their definitive treatment developed contralateral nodal
recurrence. In contrast, 8 of the 46 patients undergoing In summary, despite facing a high number of occult lymph
only ipsilateral neck dissection developed contralateral node metastasis in the ipsilateral and contralateral neck
or bilateral nodal recurrence. In the same way, for in oral cancer, the locoregional recurrence rate seems to
González-García et al. unilateral cervical dissection was be low. Surgeons should take into account the detailed
[12]
predictive for CLNM. In fact, only 1.8% of the patients that and individual study of risks and potential benefits of
primarily underwent bilateral neck dissection developed elective neck treatment for contralateral N0 neck while
CLNM, in comparison with 7.4% of those patients considering the small percentage of patients with oral
undergoing unilateral neck dissection. Remarkably, only carcinoma that finally develop CLNM.
2 of 64 patients undergoing bilateral neck dissectionas
definitive treatment developed CLNM. In contrast, 14 Adjuvant radiotherapy
of 149 patients undergoing ipsilateral neck dissection The alternative to the bilateral neck dissection is
developed CLNM. However, despite these results, they radiotherapy (RT) of the contralateral neck in the case
stated that the low reported incidence of CLNM and of a relevant risk of bilateral metastases, particularly in
the added morbidity supported recommendation for patients receiving planned adjuvant RT postoperatively.
In this way, Capote-Moreno et al. recommended bilateral
[7]
bilateral neck dissection in selected patients with tumors treatment of the neck with surgery or RT in patients
primarily arising in the midline.
with several risk factors. On the other hand, Koo et al.
[8]
showed that the patients who received adjuvant RT had
[4]
Lanzer et al. did neither show a statistical benefit of a lower locoregional control and survival rate compared
elective CND in patients with contralateral clinically with those who did not receive adjuvant RT. However, this
negative neck. Neither locoregional recurrence-free was attributed to the fact that the patients who received
survival nor overall survival rates differed.
adjuvant RT were those who had an advanced-stage
disease or worse prognosis, which would have affected
In another study, performed by Liao et al., the the locoregional control and survival rate. Finally, they
[31]
independent risk factors for the 5-year CLNM rate were suggested elective contralateral neck management with
poor differentiation, perineural invasion, and level IV/V surgery or RT in the treatment of OSCC patients with
lymph node metastases. A prognostic scoring system ipsilateral node metastasis and/or those with tumors
was thus formulated by summing up the three significant either greater than stage T3 or crossing the midline.
factors identified by multivariate analysis. In order to
reduce the incidence of CLNM, CND and adjuvant therapy The results of the Radiation Therapy Oncology Group
were recommended in high-risk patients with tongue and European Organization for Research and Treatment
cancer [score 2-3, 5-year nonrenal clearance rate (CLNR) of Cancer trials have provided evidence that in patients
40%]. In the intermediate-risk group (score 1, 5-year CLNR with head and neck cancer surgery plus concomitant
15%), neck ultrasound examinations were recommended chemoradiation (CCRT) had a better impact on clinical
every 3 months until 24 months postoperatively. outcome compared with surgery plus RT. [39,40] The benefits
Observation should be considered sufficient for low-risk of CCRT were especially evident in head and neck cancer
patients (score 0, 5-year CLNR 3%). patients with positive margins and ECS. In the study
[40]
performed by Feng et al., postoperative CCRT compared
[13]
In a recent study by Fan et al., all indications for with surgery alone improved the 5-year disease-specific
[37]
contralateral END in oropharyngeal SCC were summarised survival in these high-risk patients but did not decrease
as leading to: (1) tumours crossing the midline; (2) advanced the 5-year CLNM rate. However, it is important to take in
staging (cT34); (3) primary tumour more than 3.75 mm thick; mind that the use of CCRT in the adjuvant setting, which
(4) multiple ipsilateral node involvement; and (5) tumours is highly toxic, may cause immunosuppression. For
[41]
arising in the base of the tongue and floor of the mouth. these authors, whether high-risk patients benefit from
186 Plast Aesthet Res || Volume 3 || June 24, 2016