This study concerns 75 patients with squamous cell carcinoma of the oral cavity who were patients at the Gustave-Roussy Institute between December 1966 and July 1973. These patients were divided into two groups. The first group was comprised of 39 patients who underwent elective radical neck dissection; nodal involvement was present in 49% with capsular rupture in 13%. In the second group of 36, neck disease appeared during follow up in 19 cases. Therapeutic radical neck dissection was carried out in 17; the nodes were histologically positive in 15, 9 of which had a capsular rupture. In 2 cases, local or general conditions did not permit operative intervention. In this group, the involvement rate was 47% with a 25% capsular rupture rate. However, the comparison of the survival curves by the log-rank test did not reveal any differences, even though histologic prognostic factors were taken into account. These findings led to the conclusion that in squamous cell carcinoma of the oral cavity staged TINo, T,No, or T,N,, (from AJC's and UICC's clinical staging system), it seems possible, without risk, to delay neck dissection until a node is detectable, although it is reasonable to perform elective neck dissection in those cases in which the patient is unavailable for regular followup.
Cancer 46:386-390, 1980.
N CASES OF squamous cell carcinoma of the oral I cavity without evidence of clinical lymph node involvement, the management of the cervical area depends mostly upon the treatment of the primary tumor. If interstitial curietherapy is planned, a decision must to be made as to the treatment of the cervical lymph node area. There are two options: 1) to perform an elective neck dissection at once; or 2 ) to wait until there is evidence of disease and then carry out a delayed therapeutic dissection. The proponents of the first method point out the high rate of histologically positive nodes in clinically disease-free necks (from 36 to 49% found at elective s ~r g e r y ) , ~, * , ~ and the often rapid growth of the nodes when they ultimately appear. However, others believe that surgery is useless or even harmful when histologic involvement is not evident, not to mention the patient's pain, shoulder disability, and the cosmetic effects after major neck surgery. Furthermore, acute nodal growth From the Departments of *Head and Neck, t Statistics (Clinical Research), $Curietherapy , and