Neck and neck.
Top Line: Does sentinel node biopsy have equivalent cancer outcomes to neck dissection for patients with early stage oral cavity cancer?
The Study: In 2015, a randomized trial showed that elective neck dissection (ND) at the time of initial surgery improves survival for early-stage, clinically node-negative oral cavity squamous cell carcinoma. In that trial, while only 30% of elective ND had occult nodal disease, 45% of patients who didn’t have up-front dissection had a recurrence in the neck. This generated a hypothesis that perhaps ND removed disease so occult it wasn't appreciated even on histopathology. Senti-MERORL is a trial that sought to determine if sentinel node biopsy (SNB) was equivalent to ND in patients with T1-2N0 oral cavity SCC. SNB was done with radiotracer and lymphoscintigraphy prior to surgery. SNB+ patients had subsequent immediate (if positive on frozen path) or staged (if positive on final path) ND. Among those who had tracer localization and underwent SNB, 25% were positive (16% on frozen and 9% on final). In comparison, 22% of ND patients had positive nodes. The rate of neck-only recurrence was similar for ND (10%) vs SNB (9%), and at 2 years, there was no difference in the primary outcome of neck nodal recurrence-free survival (~90%). There were no differences in 2- or 5-year locoregional recurrence-free or overall survival. While morbidity and neck/shoulder/arm function were worse immediately after ND, those differences diminished 12-24 months after surgery.TBL: Sentinel node biopsy for T1-2N0 oral cavity cancer does not appear to increase the risk of neck recurrence, spares two-thirds of patients from full neck dissection, and has better short-term functional outcomes. | Gerrel, J Clin Oncol 2020