5
Recommendation 4.3
➤ Patients with tumors extending to the midline tongue-base or palate
or involving the posterior oropharyngeal wall should have bilateral
neck dissections performed unless bilateral adjuvant radiotherapy
is planned. The multidisciplinary team should discuss with patients
the potential functional impact of bilateral neck dissection and post-
operative adjuvant radiation therapy with or without chemotherapy.
(Moderate Recommendation; EB-I-B)
Recommendation 5.1
➤ A non-surgical approach should be offered to patients with
cN+ disease who have either unequivocal extranodal extension
into surrounding soft tissues or carotid artery or cranial nerve
involvement. (Moderate Recommendation; EB-I-B)
Recommendation 5.2
➤ Patients with biopsy-proven distant metastases should not undergo
routine surgical resection of metastatic cervical lymph nodes.
(Strong Recommendation; EB-I-B)
Recommendation 6.1a
➤ If PET/CT scan at ≥12 weeks after completion of radiation/
chemoradiation shows intense FDG uptake in any node, the patient
should have a neck dissection if feasible. If PET/CT shows no
nodal FDG uptake, and the patient has no abnormally enlarged
lymph nodes, the patient should not have neck dissection. (Strong
Recommendation; EB-H-B)
Recommendation 6.1b
➤ Patients who complete radiation/chemoradiation and have anatomic
cross-sectional imaging (CT or MRI scans) at ≥12 weeks post therapy
showing resolution of previously abnormal lymph nodes should not
have neck dissection. (Strong Recommendation; EB-I-B)
Recommendation 6.2
➤ If PET/CT scan at ≥12 weeks shows mild FDG uptake in a node
≤1 cm or a persistently enlarged node ≥1 cm without either mild or
intense FDG uptake, that patient may be followed closely with serial
cross-sectional imaging or PET/CT, with neck dissection reserved for
clinical or radiographic concern for progressive disease.
(Moderate Recommendation; EB-I-B)
