Elective Neck Dissection May Be Beneficial in Predicting Occult Metastasis

Is elective neck dissection beneficial for patients with oral cavity squamous cell carcinomas (SCCs) of the maxillary alveolus or the hard palate to predict occult metastasis?

Background: Oral cavity SCC of the maxillary alveolus and hard palate are much less common than cancers of the tongue and floor of the mouth, and few studies have investigated the management and outcome of SCC in these oral cavity subsites.

Design: Cohort study with prospective data collection.

Setting: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

Synopsis: A study of 97 patients with SCC of the maxillary alveolus and hard palate were treated with primary surgery eligible for inclusion. The study spanned 15 years, from 1994 to 2008. All patients with apparent nodal disease on presentation had elective neck dissection at the discretion of the treating surgeon. Maxillary alveolus tumors made up 90.7 percent of the study population, and 9.3 percent were of the hard palate. Of the patients with neck dissections, five were pathologically negative. Occult nodal metastases were found in 11 specimens. The true occult metastasis rate is 26 percent. Maxillary alveolus and hard palate tumors are unique and occur more commonly in women than squamous cell carcinomas of the tongue and floor of the mouth. Elective neck dissection was used much more frequently than adjuvant radiotherapy; therefore, patients who did not undergo neck dissection had early staged tumors at presentation. Those who did not receive primary surgery received less post-operative radiotherapy.

Bottom line: High rates of occult nodal metastases and several independent predictors of disease-free survival were demonstrated in the study. Additionally, the study data suggest that elective neck dissection in some patients may be beneficial in offering more exact staging data that can then guide disease management.

Citation: Eskander A, Givi B, Gullane PJ, et al. Outcome predictors in squamous cell carcinoma of the maxillary alveolus and hard palate. Laryngoscope. 2013;123:2453-2458.

—Reviewed by Amanda Rillo