Medical Oncology

, 36:40 | Cite as

Neck management in head and neck squamous cell carcinomas: where do we stand?

  • Guillaume KlausnerEmail author
  • Idriss Troussier
  • Eivind Blais
  • Florent Carsuzaa
  • Thomas Zilli
  • Raymond Miralbell
  • Francesca Caparrotti
  • Juliette Thariat
Review Article


Head and neck squamous-cell carcinomas (HNSCCs) have a significant lymph node tropism. This varies considerably depending on the primary tumor site and the Human Papillomavirus (HPV) status of the disease. The best therapeutic option, between up-front lymph node dissection and chemoradiotherapy (CRT) +/− followed by lymph node dissection in case of persistent lymphadenopathy or regional relapse, remains unclear. The purpose of this review is to discuss the pros and cons related to the different approaches of the neck management in HNSCC. A narrative review of the management of the cervical lymph nodes was undertaken. Searches of PubMed database were performed using the terms ‘neck management’ OR ‘cervical lymphadenopathies’ AND ‘head and neck neoplasms’. Recent advances in imaging, pathological analysis, surgery and radiotherapy let to personalize the type of lymph node dissection and, the volumes of radiation therapy. Excluding inoperable patients and unresectable diseases, N3 lymphadenopathies, as well as bulky N2 stages, specifically HPV− or necrotic nodes, would be in favor of an up-front surgical approach, while HPV+ diseases, and lymphadenopathies of unknown primary would support CRT first. However, efficacy of such strategies is challenged by a significant morbidity in the medium and long terms. In the absence of higher level of evidence, the decision-making tools for the neck dissection before or after the CRT are based on the Mehanna’s trial and retrospective studies with significant biases. Consequently, the approaches and the ensuing outcomes remain not homogenous depending on the centers’ experience, in the context of limited data, especially for N2–3 HPV− HNSCC.


Head and neck neoplasms Neck dissection Radiotherapy Disease management Lymphadenopathy Combined modality therapy 




Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No object.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Radiation Oncology Department, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière Charles-FoixSorbonne UniversityParisFrance
  2. 2.Radiation Oncology DepartmentHôpitaux Universitaires de Genève (HUG)Geneva 14Switzerland
  3. 3.Head and Neck Surgery DepartmentCentre Hospitalier Universitaire (CHU) de PoitiersPoitiersFrance
  4. 4.Radiation Oncology Department, François Baclesse Center/ARCHADENormandy UniversityCaenFrance

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