1. Elective neck dissections offered no significant survival advantage for patients who did not have any evidence of neck metastases.
2. The subset of patients with high risks of neck metastases and/or advanced T classifications also did not benefit from elective neck dissections.
Evidence Rating Level: 2 (Good)
Study Rundown: Adenoid cystic carcinoma (ACC) is a malignant tumor that accounts for 3-5% of all head and neck cancers. Primary tumor resections followed by therapeutic neck dissections comprise today’s standard ACC treatment protocol in cases of confirmed neck metastases. However, it is unclear whether elective neck dissections (ENDs) are needed in ACC patients who do not have any clinical or radiologic evidence of neck metastases. In this study, the authors compared the survival of patients undergoing ENDs with the survival of those not undergoing ENDs to determine whether patients benefited from this elective procedure. They found that there was no statistically significant difference between the 2 groups in any survival measures. In the subgroup analyses, they further examined the effects of high metastatic risk and advanced T classifications on survival outcomes and found that these subsets also did not affect survival. An important strength of this study is its large sample size. However, this study is limited by its retrospective study design which resulted in missing data and heterogeneity in data collection.
In-Depth [retrospective study]: This was a retrospective study involving 457 patients from 9 international cancer centers. All included patients had no preoperative clinical or radiologic evidence of neck metastases confirmed by physical exam and imaging studies with either CT or PET-CT. A total of 226 patients (49%) underwent primary tumor resections followed by END while in 231 patients (51%), only the primary tumors were resected. The Kaplan-Meier method was used to analyze survival measures such as the 5-year overall survival, disease-specific survival, disease-free survival and distant metastases rates. In this study, the authors found that the incidence of occult neck metastases among the included patients was 17%. Despite the high rate of occult metastases, statistical analyses revealed that END offered no significant survival advantage in patients with ACC in all survival measures. The study recommends considering routine imaging methods for follow-up in this population.
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