Management of the clinically N0 neck in oral and oropharyngeal carcinoma in Scotland

The management of the clinically N0 (cN0) neck in patients with oral and oropharyngeal squamous cell carcinomas (SCC) remains controversial. Factors such as patient comorbidity, different personal opinions, pathological factors and other factors modify the treatment decisions. Our primary aim was to determine the management of the cN0 neck in oral and oropharyngeal SCC patients in different institutions in Scotland. The secondary aim was to evaluate the outcome of the patients who had not undergone any treatment of the neck in comparison with those who had undergone elective neck treatment, and also examine factors relating to overall survival in this population. Based on a prospective head and neck cancer audit carried out in Scotland between September 1999 and October 2001, we focused on the management of N0 neck in patients with oral or oropharyngeal SCC. Out of a total of 1,910 patients in the audit, 364 patients with oral or oropharyngeal SCC and cN0 neck were treated with curative intent. The overall survival data was available up to a minimum of 5 years, and a detailed clinical follow-up to a minimum of 18 months. One hundred patients had no treatment to the neck (observation group). A total of 112 patients received prophylactic neck (chemo)-irradiation without elective neck dissection (END). END was performed for 152 patients (of which 23 were bilateral), and 63 of them received postoperative radiotherapy. Histopathological examination revealed metastases in only 16% of the dissection specimens. In the observation group, six patients (6%) had a recurrence in the neck without any recurrence at the primary site. For the rest of the patients who had any sort of elective neck treatment, the respective figure was also 6% (15/264). Neck imaging was recorded in 186 patients only. There is a wide variation in the management of the cN0 within Scotland. The use of imaging for diagnosis is also variable. A surprisingly low percentage of patients proved to have had metastasis on pathological examination. Despite variations in treatment, neck recurrence was relatively uncommon. This audit demonstrates the need for more defined protocols for the management of the cN0.