Recommendation 1.1b. For patients with SCCOC classiﬁed as cT1, cN0, an ipsilateral elective neck dissection should be performed. Alternatively, for selected highly reliable patients with cT1, cN0, close surveillance may be offered by a surgeon in conjunction with specialized neck ultrasound surveillance techniques.
Explore This IssueJuly 2019
Recommendation 1.2a. For patients with a cN0 neck, an ipsilateral elective neck dissection should include nodal levels, Ia, Ib, II, and III. An adequate dissection should include at least 18 lymph nodes.
Recommendation 1.2b. An ipsilateral therapeutic selective neck dissection for a clinically node-positive (cN+) neck should include nodal levels Ia, Ib, IIa, IIb, III, and IV. An adequate dissection should include at least 18 lymph nodes. Dissection of level V may be offered in patients with multistation disease.
Recommendation 1.3. In patients with a cN+ contralateral neck, contralateral neck dissection should be performed.
Recommendation 2.1a. Adjuvant neck radiotherapy should not be administered to patients with pN0 or a single pN1 without extranodal extension after high-quality neck dissection, unless there are indications from the primary tumor characteristics.
Recommendation 2.1b. Adjuvant neck radiotherapy should be administered to patients with oral cavity cancer and pN1 who did not undergo high-quality neck dissection.
Recommendation 2.2. Adjuvant neck radiotherapy should be administered to patients with oral cavity cancer and pathologic N2 or N3 disease.
Recommendation 2.3b. Weekly cisplatin may be administered with post-op radiotherapy to patients who are considered inappropriate for standard high-dose intermittent cisplatin.
Recommendation 4.1. Patients with lateralized oropharyngeal carcinoma who are being treated with upfront curative surgery should undergo an ipsilateral neck dissection of levels II to IV. An adequate dissection should include at least 18 lymph nodes.
Recommendation 5.1. A nonsurgical approach should be offered to patients with cN+ disease who have either unequivocal extranodal extension into surrounding soft tissues or carotid artery or cranial nerve involvement.
Recommendation 5.2. Patients with biopsy-proven distant metastases should not undergo routine surgical resection of metastatic cervical lymph nodes.
Recommendation 6.1a. If PET/ CT scan at 12 or more weeks after completion of radiation/chemoradiation shows intense FDG uptake in any node, the patient should undergo neck dissection if feasible. If PET/CT shows no nodal FDG uptake and the patient has no abnormally enlarged lymph nodes, the patient should not have neck dissection.
Recommendation 6.1b. Patients who complete radiation/chemoradiation and receive anatomic cross-sectional imaging at 12 or more weeks post-therapy that shows resolution of previously abnormal lymph nodes should not undergo neck dissection.