ASCO 2015: Elective Neck Dissection Improves Early Oral Cancer Survival


Key Points

  • For patients with early-stage oral cancer, elective neck dissection improved overall survival by 12.5% compared to a wait-and-watch approach leading to therapeutic neck dissection with nodal relapse.
  • Elective neck dissection reduced risk of death by 36% and risk of recurrences by 55% compared to a wait-and-watch approach.

A randomized phase III study resolves long-standing questions about the optimal timing of neck lymph node surgery for patients with early-stage oral cancer by showing that elective neck dissection both improves survival and lowers recurrence rates compared to therapeutic neck dissection performed at the time of nodal occurrence. “Elective neck dissection should be the standard of care for early oral node-negative squamous cell cancers based on the findings of our trial,” the study’s lead author, Anil D’Cruz, MBBS, MS, FRCS, stated at a press briefing at the 2015 ASCO Annual Meeting in Chicago. Dr. D’Cruz, Professor and Chief, Department of Head and Neck Surgery at Tata Memorial Centre in Mumbai, India, also presented the study results at today’s Plenary Session (Abstract LBA3). 

“This has been a matter of considerable debate in the head and neck community that has gone on for more than 5 decades,” Dr. D’Cruz said. “Our study is the first to conclusively prove that more lives can be saved with elective neck dissection,” he stated.

37% Reduction in Risk of Death

The trial, conducted at Tata Memorial Centre between 2004 and 2014, randomly assigned 596 patients with early-stage oral squamous cancer. All patients had excision of the primary tumor and were randomly assigned to elective neck dissection or a “wait-and-watch” approach leading to therapeutic neck dissection with nodal relapse. Adjuvant therapy was an option when indicated. Dr. D’Cruz presented results for the first 500 patients.

“Elective neck dissection improves overall survival by 12.5% compared to a wait-and-watch approach and reduces risk of death by 36%,” Dr. D’Cruz reported. In addition, elective neck dissection “reduces the risk of recurrences in the neck compared to the wait-and-watch approach by 55%,” he said.

“For every eight patients who undergo elective neck dissection, one death is prevented. For every four patients who undergo elective neck dissection, one recurrence is prevented,” Dr. D’Cruz continued.  

“Armed with the results of this study, doctors will be able to confidently counsel patients that adding neck surgery to their initial treatment is worthwhile,” he concluded.

‘One and Done Approach’

The study findings “potentially can affect the lives of over 300,000 people with oral cancer globally. This is particularly important in countries and in populations where there are multiple barriers to health care,” commented ASCO spokesperson and press briefing moderator Jyoti D. Patel, MD, Associate Professor of Medicine, Division of Hematology/Oncology at Northwestern University Feinberg School of Medicine, Chicago. “This ‘one and done’ approach we know now definitively improves survival.”

This study received funding from the institutional research grants of the Tata Memorial Centre. Dr. D'Cruz reported participation in a speakers’ bureau with Merck Serono, and research funding (institutional) from GlaxoSmithKline.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.