Sentinel node biopsy versus elective neck dissection in early-stage oral cancer: a systematic review.
Neck dissection
Oral cancer
Sentinel node biopsy
Journal
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
ISSN: 1434-4726
Titre abrégé: Eur Arch Otorhinolaryngol
Pays: Germany
ID NLM: 9002937
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
10
04
2020
accepted:
26
05
2020
pubmed:
1
6
2020
medline:
27
3
2021
entrez:
1
6
2020
Statut:
ppublish
Résumé
To provide a summary of the evidence on the comparative effectiveness of two surgical treatment strategies, sentinel node biopsy (SNB) and elective neck dissection (END), in patients with T1-T2 oral cancer and clinically negative (cN0) neck, in terms of overall survival (OS), disease-free survival (DFS) and neck recurrence rates (NRRs). A systematic review was performed by including studies published up to April 2019. Meta-analysis was performed to compare NRRs between SNB and END. A narrative summary of the results was generated for OS, DFS and morbidity outcomes. The certainty of evidence was assessed according to the GRADE methodology. No randomized studies were retrieved. Five observational studies were included in the comparative effectiveness analysis and four observational studies were included in the comparative morbidity analysis. The pooled risk ratio showed no differences in NRRs between SNB and END (10.5% vs 11.6%; pooled RR 1.09; 95% CI 0.67-1.76). No differences in OS or DFS between the two treatments were found. SNB appears to be associated with a lower rate of postoperative complications and lower shoulder dysfunction than END. Conversely, the results of the quality of life (QoL) questionnaires are not sufficient to advocate a particular strategy. Our review highlights the lack of well conducted and randomized studies comparing SNB to END, leading to poor clinical evidence. Although our findings suggest no significant differences in OS, DFS and NRR between the two strategies, the certainty of our evidence is too low to make it useful for clinical decision making.
Identifiants
pubmed: 32474648
doi: 10.1007/s00405-020-06090-9
pii: 10.1007/s00405-020-06090-9
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
3247-3260Commentaires et corrections
Type : CommentIn
Références
Ebrahimi A, Ashford BG, Clark JR (2012) Improved survival with elective neck dissection in thick early-stage oral squamous cell carcinoma. Head Neck 34:709–716. https://doi.org/10.1002/hed.21809
doi: 10.1002/hed.21809
pubmed: 21739519
de Bree R, Takes RP, Shah JP, Hamoir M, Kowalski LP, Robbins KT et al (2019) Elective neck dissection in oral squamous cell carcinoma: past, present and future. Oral Oncol 90:87–93. https://doi.org/10.1016/j.oraloncology.2019.01.016
doi: 10.1016/j.oraloncology.2019.01.016
pubmed: 30846183
D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R et al (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373:521–529. https://doi.org/10.1056/NEJMoa1506007
doi: 10.1056/NEJMoa1506007
Abu-Ghanem S, Yehuda M, Carmel NN, Leshno M, Abergel A, Gutfeld O et al (2016) Elective neck dissection vs observation in early-stage squamous cell carcinoma of the oral tongue with no clinically apparent lymph node metastasis in the neck: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 142:857–865. https://doi.org/10.1001/jamaoto.2016.1281
doi: 10.1001/jamaoto.2016.1281
pubmed: 27442962
Ren ZH, Xu JL, Li B, Fan TF, Ji T, Zhang CP (2015) Elective versus therapeutic neck dissection in node-negative oral cancer: evidence from five randomized controlled trials. Oral Oncol 51:976–981. https://doi.org/10.1016/j.oraloncology.2015.08.009
doi: 10.1016/j.oraloncology.2015.08.009
pubmed: 26321080
Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, Olivatto LO (1994) Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg 168:391–394. https://doi.org/10.1016/s0002-9610(05)80082-0
doi: 10.1016/s0002-9610(05)80082-0
pubmed: 7977957
Stoeckli SJ (2007) Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck Candidate’s thesis. Laryngoscope 117:1539–1551. https://doi.org/10.1097/MLG.0b013e318093ee67
doi: 10.1097/MLG.0b013e318093ee67
pubmed: 17667135
Alkureishi LWT, Ross GL, Stoeckli SJ (2010) Sentinel node biopsy in oral cancer. In: Myers J (ed) Oral Cancer Metastasis. Springer, New York, pp 49–74
Ross GL, Soutar DS, Gordon MacDonald D, Shoaib T, Camilleri I, Roberton AG et al (2004) Sentinel node biopsy in head and neck cancer: preliminary results of a multicenter trial. Ann Surg Oncol 11:690–696. https://doi.org/10.1245/ASO.2004.09.001
doi: 10.1245/ASO.2004.09.001
pubmed: 15197011
Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R et al (2010) Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol 28:1395–1400. https://doi.org/10.1200/JCO.2008.20.8777
doi: 10.1200/JCO.2008.20.8777
pubmed: 20142602
pmcid: 2834497
Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA et al (2015) Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 51:2777–2784. https://doi.org/10.1016/j.ejca.2015.08.023
doi: 10.1016/j.ejca.2015.08.023
pubmed: 26597442
Liu M, Wang SJ, Yang X, Peng H (2017) Diagnostic efficacy of sentinel lymph node biopsy in early oral squamous cell carcinoma: a meta-analysis of 66 studies. PLoS ONE 12:e0170322. https://doi.org/10.1371/journal.pone.0170322
doi: 10.1371/journal.pone.0170322
pubmed: 28107500
pmcid: 5249063
Paleri V, Rees G, Arullendran P, Shoaib T, Krishman (2005) Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: a diagnostic meta-analysis. Head Neck 27:739–747. https://doi.org/10.1002/hed.20228
doi: 10.1002/hed.20228
pubmed: 16047368
Govers TM, Hannink G, Merkx MA, Takers RP, Rovers MM (2013) Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: a diagnostic meta-analysis. Oral Oncol 49:726–732. https://doi.org/10.1016/j.oraloncology.2013.04.006
doi: 10.1016/j.oraloncology.2013.04.006
pubmed: 23680537
Stoeckli SJ, Steinert H, Pfaltz M, Schmid S (2001) Sentinel lymph node evaluation in squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 125:221–226. https://doi.org/10.1067/mhn.2001.118074
doi: 10.1067/mhn.2001.118074
pubmed: 11555757
Ross GL, Shoaib T, Scott J, Soutar DS, Grey HW, MacKie R et al (2002) The learning curve for sentinel node biopsy in malignant melanoma. Brit J Plast Surg 55:298–301. https://doi.org/10.1054/bjps.2002.3825
doi: 10.1054/bjps.2002.3825
pubmed: 12160535
Ross GL, Shoaib T, Soutar DS, MacDonald DG, Camiller IG, Bessent RG et al (2002) The first international conference on sentinel node biopsy in mucosal head and neck cancer and adoption of a multicenter trial protocol. Ann Surg Oncol 9:406–410. https://doi.org/10.1007/bf02573877
doi: 10.1007/bf02573877
pubmed: 11986194
Alkureishi LWT, Burak Z, Alvarez JA, Ballinger J, Bilde A, Britten AJ et al (2009) Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral/oropharyngeal squamous cell carcinoma. Ann Surg Oncol 16:3190–3210. https://doi.org/10.1245/s10434-009-0726-8
doi: 10.1245/s10434-009-0726-8
pubmed: 19795174
pmcid: 2766455
Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. https://gdt.gradepro.org/app/handbook/handbook.html
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed1000097
doi: 10.1371/journal.pmed1000097
pubmed: 19621072
pmcid: 2707599
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses, 2012. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015 (developed by Evidence Prime, Inc.). Available from gradepro
Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014
Hernando J, Villarreal P, Alvarez-Marcos F, Garcia-Consuegra L, Gallego L, Junquera L (2016) Sentinel node biopsy versus elective neck dissection. Which is more cost-effective? A prospective observational study. J Cranio-MaxilloFac Surg 44:550–556. https://doi.org/10.1016/j.jcms.2016.01.017
doi: 10.1016/j.jcms.2016.01.017
Moya-Plana A, Aupérin A, Guerlain J, Gorphe P, Casiraghi O, Mamelle G et al (2018) Sentinel node biopsy in early oral squamous cell carcinomas: long-term follow-up and nodal failure analysis. Oral Oncol 82:187–194. https://doi.org/10.1016/j.oraloncology.2018.05.021
doi: 10.1016/j.oraloncology.2018.05.021
pubmed: 29909896
Seferin MR, Pinto FR, Lin CS, Leite AKN, Gimenes PVS, Dedivitis RA et al (2018) Sentinel lymph node biopsy in early oral cavity tumors: evaluation of the oncologic efficacy compared to elective neck dissection. Arch Head Neck Surg 47:e0876. https://doi.org/10.4322/ahns.2018.0876
doi: 10.4322/ahns.2018.0876
Alkureishi LWT, Ross GL, Shoaib T, Soutar DS, Robertson AG, Thompson R et al (2010) Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial. Ann Surg Oncol 17:2459–2464. https://doi.org/10.1245/s10434-010-1111-3
doi: 10.1245/s10434-010-1111-3
pubmed: 20552410
Alvarez J, Bidaguren A, McGurk M, Diaz-Basterra G, Brunsò J, Andikoetxea B et al (2014) Sentinel node biopsy in relation to survival in floor of the mouth carcinoma. Int J Oral Maxillofac Surg 43:269–273. https://doi.org/10.1016/j.ijom.2013.10.022
doi: 10.1016/j.ijom.2013.10.022
pubmed: 24296067
Hernando J, Villarreal P, Álvarez-Marcos F, Gallego L, Garcia-Consuegra L, Junquera L (2014) Comparison of related complications: sentinel node biopsy versus elective neck dissection. Int J Oral Maxillofac Surg 43:1307–1312. https://doi.org/10.1016/j.ijom.2014.07.016
doi: 10.1016/j.ijom.2014.07.016
pubmed: 25128262
Murer K, Huber GF, Haile SR, Stoeckli SJ (2011) Comparison of morbidity between sentinel node biopsy and elective neck dissection for treatment of the N0 neck in patients with oral squamous cell carcinoma. Head Neck 33:1260–1264. https://doi.org/10.1002/hed.21622
doi: 10.1002/hed.21622
pubmed: 21837694
Flach GB, Verdonck-de Leeuw IM, Witte BI, Klop WM, van Es RJ, Schepman KP, de Bree R (2016) Patients’ perspective on the impact of sentinel node biopsy in oral cancer treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 122:279–286. https://doi.org/10.1016/j.oooo.2016.03.014
doi: 10.1016/j.oooo.2016.03.014
pubmed: 27262509
Schiefke F, Akdemir M, Weber A, Akdemir D, Singer S, Frerich B (2009) Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection. Head Neck 31:503–512. https://doi.org/10.1002/hed.21001
doi: 10.1002/hed.21001
pubmed: 19156833
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual, 7th edn. Springer, New York
Paleri V, Subramaniam S, Oozeer N, Rees G, Krishnan S (2008) Dissection of the submuscular recess (sublevel IIb) in squamous cell cancer of the upper aerodigestive tract: prospective study and systematic review of the literature. Head Neck 30:194–200. https://doi.org/10.1002/hed.20682
doi: 10.1002/hed.20682
pubmed: 17712854
Wang L, Wang L, Song X, Cui C, Ma C, Guo B, Qin X (2019) The necessity of IIb dissection in T1–T2N0M0 oral squamous cell carcinoma: protocol for a randomized controlled trial. Trials 20:600. https://doi.org/10.1186/s13063-019-3683-y
doi: 10.1186/s13063-019-3683-y
pubmed: 31640763
pmcid: 6805579
National Comprehensive Cancer Network. Head and neck cancer clinical practice guidelines in oncology. Updated February 2020. https://www.nccn.org/professionals/physician_gls/default.aspx . Accessed March 1, 2020
Vandenbrouck C, Sancho-Garnier H, Chassagne D, Saravane D, Cachin Y, Micheau C (1980) Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial. Cancer 46:386–390. https://doi.org/10.1002/1097-0142(19800715)46:2%3c386:aid-cncr2820460229%3e3.0.co;2-9
doi: 10.1002/1097-0142(19800715)46:2<386::aid-cncr2820460229>3.0.co;2-9
pubmed: 6992980
Fakih AR, Rao RS, Borges AM, Patel AR (1989) Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 158:309–313. https://doi.org/10.1016/0002-9610(89)90122-0
doi: 10.1016/0002-9610(89)90122-0
pubmed: 2802032
Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW et al (2009) Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck 31:765–772. https://doi.org/10.1002/hed.21033
doi: 10.1002/hed.21033
pubmed: 19408291
Brown JS, Shaw RJ, Bekiroglu F, Rogers SN (2012) Systematic review of the current evidence in the use of postoperative radiotherapy for oral squamous cell carcinoma. Br J Oral Maxillofac Surg 50:481–489. https://doi.org/10.1016/j.bjoms.2011.08.014
doi: 10.1016/j.bjoms.2011.08.014
pubmed: 22196145
Ganly I, Goldstein D, Carlson DL, Patel SG, O’Sullivan B, Lee N et al (2013) Long-term regional control and survival in patients with “low-risk,” early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation: the importance of tumor thickness. Cancer 119:1168–1176. https://doi.org/10.1002/cncr.27872
doi: 10.1002/cncr.27872
pubmed: 23184439
Pezier T, Nixon IJ, Gurney B, Schilling C, Hussain K, Lyons AJ et al (2012) Sentinel lymph node biopsy for T1/T2 oral cavity squamous cell carcinoma: a prospective case series. Ann Surg Oncol 19:3528–3533. https://doi.org/10.1245/s10434-011-2207-0
doi: 10.1245/s10434-011-2207-0
pubmed: 22411202
Samant S (2014) Sentinel node biopsy as an alternative to elective neck dissection for staging of early oral carcinoma. Head Neck 36:241–246. https://doi.org/10.1002/hed.23288
doi: 10.1002/hed.23288
pubmed: 23729239
Terada A, Hasegawa Y, Yatabe Y, Hanai N, Ozawa T, Hirakawa H et al (2011) Follow-up after intraoperative sentinel node biopsy of N0 neck oral cancer patients. Eur Arch Otorhinolaryngol 268:429–435. https://doi.org/10.1007/s00405-010-1364-2
doi: 10.1007/s00405-010-1364-2
pubmed: 20725756
Pedersen NJ, Jensen DH, Hedback N, Frendo M, Kiss K, Lelkaitis G et al (2016) Staging of early lymph node metastases with the sentinel lymph node technique and predictive factors in T1/T2 oral cavity cancer: a retrospective single-center study. Head Neck 38(Suppl 1):E1033–E1040. https://doi.org/10.1002/hed.24153
doi: 10.1002/hed.24153
pubmed: 26040238
Flach GB, Bloemena E, Klop WM, van Es RJ, Schepman KP, Hoekstra OS et al (2014) Sentinel lymph node biopsy in clinically N0 T1-T2 staged oral cancer: the Dutch multicenter trial. Oral Oncol 50:1020–1024. https://doi.org/10.1016/j.oraloncology.2014.07.020
doi: 10.1016/j.oraloncology.2014.07.020
pubmed: 25164950
Rigual N, Loree T, Frustino J, Jayaprakash V, Cohan D, Sullivan M et al (2013) Sentinel node biopsy in lieu of neck dissection for staging oral cancer. JAMA Otolaryngol-Head Neck Surg 139:779–782. https://doi.org/10.1001/jamaoto.2013.3863
doi: 10.1001/jamaoto.2013.3863
pubmed: 23868306
Hingsammer L, Seier T, Zweifel D, Huber G, Rucker M, Bredell M et al (2019) Sentinel lymph node biopsy for early stage tongue cancer: a 14-year single-centre experience. Int J Oral Maxillofac Surg 48:437–442. https://doi.org/10.1016/j.ijom.2018.10.011
doi: 10.1016/j.ijom.2018.10.011
pubmed: 30389112
Bluemel C, Rubello D, Colletti PM, de Bree R, Herrmann K (2015) Sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma: current status and unresolved challenges. Eur J Nucl Med Mol Imaging 42:1469–1480. https://doi.org/10.1007/s00259-015-3049-y
doi: 10.1007/s00259-015-3049-y
pubmed: 25916741
Keski-Säntti H, Atula T, Törnwall J, Koivunen P, Mäkitie A (2006) Elective neck treatment versus observation in patients with T1/T2 N0 squamous cell carcinoma of oral tongue. Oral Oncol 42:96–101. https://doi.org/10.1016/j.oraloncology.2005.06.018
doi: 10.1016/j.oraloncology.2005.06.018
pubmed: 16256414
Capote A, Escorial V, Munoz-Guerra MF, Rodriguez-Campo FJ, Gamallo C, Naval L (2007) Elective neck dissection in early stage oral squamous cell carcinoma does it influence recurrence and survival? Head Neck 29:3–11. https://doi.org/10.1002/hed.20482
doi: 10.1002/hed.20482
pubmed: 17103411
D’Cruz AK, Siddachari RC, Walvekar RR, Pantvaidya GH, Chaukar DA et al (2009) Elective neck dissection for the management of the N0 neck in early cancer of the oral tongue: need for a randomized controlled trial. Head Neck 31:618–624. https://doi.org/10.1002/hed.20988
doi: 10.1002/hed.20988
pubmed: 19132717
Huang SF, Kang CJ, Lin CY, Fan KH, Yen TC et al (2008) Neck treatment of patients with early stage oral tongue cancer: comparison between observation, supraomohyoid dissection, and extended dissection. Cancer 112(5):1066–1075. https://doi.org/10.1002/cncr.23278
doi: 10.1002/cncr.23278
pubmed: 18246535
Yuen AP, Wei WI, Wong YM, Tang KC (1997) Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck 19:583–588. https://doi.org/10.1002/(sici)1097-0347(199710)19:7%3c583:aid-hed4%3e3.0.co;2-3
doi: 10.1002/(sici)1097-0347(199710)19:7<583::aid-hed4>3.0.co;2-3
pubmed: 9323146
Patel TD, Vázquez A, Marchiano E et al (2016) Efficacy of elective neck dissection in T1/T2N0M0 oral tongue squamous cell carcinoma: a population-based analysis. Otolaryngol Head Neck Surg 155:588–597. https://doi.org/10.1177/0194599816643695
doi: 10.1177/0194599816643695
pubmed: 27165672
Kelner N, Vartanian JG, Pinto CA, Coutinho-Camillo CM, Kowalski LP (2014) Does elective neck dissection in T1/T2 carcinoma of the oral tongue and floor of the mouth influence recurrence and survival rates? Br J Oral Maxillofac Surg 52(7):590–597. https://doi.org/10.1016/j.bjoms.2014.03.020
doi: 10.1016/j.bjoms.2014.03.020
pubmed: 24840539
Broglie MA, Haerle SK, Huber GF, Haile SR, Stoeckli SJ (2013) Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: impact on survival. Head Neck 35:660–666. https://doi.org/10.1002/hed.23017
doi: 10.1002/hed.23017
pubmed: 22605675
Den Toom IJ, Heuveling DA, Flach GB, van Weert S, Karagozoglu KH et al (2015) Sentinel node biopsy for early-stage oral cavity cancer: the VU University Medical Center experience. Head Neck 37:573–578. https://doi.org/10.1002/hed.23632
doi: 10.1002/hed.23632
Amin MB, Edge SB, Greene FL et al (2017) AJCC cancer staging manual, 8th edn. Springer, New York
doi: 10.1007/978-3-319-40618-3
Gane EM, Michaleff ZA, Cottrell MA, McPhail SM, Hatton AL, Panizza BJ et al (2017) Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review. Eur J Surg Oncol 43:1199–1218. https://doi.org/10.1016/j.ejso.2016.10.026
doi: 10.1016/j.ejso.2016.10.026
pubmed: 27956321
Civantos FJ, Stoeckli SJ, Takes RP, Woolgar JA, de Bree R, Paleri V et al (2010) What is the role of sentinel node biopsy in the management of oral cancer in 2010? Eur Arch Otorhinolaryngol 267:839–844. https://doi.org/10.1007/s00405-010-1215-1
doi: 10.1007/s00405-010-1215-1
pubmed: 20204392
pmcid: 2857796
Schilling C, Shaw R, Schache A, McMahon J, Chegini S, Kerawala C et al (2017) Sentinel lymph node biopsy for oral squamous cell carcinoma. Where are we now? Br J Oral Maxillofac Surg 55:757–762. https://doi.org/10.1016/j.bjoms.2017.07.007
doi: 10.1016/j.bjoms.2017.07.007
pubmed: 28864148
Schilling C, Stoeckli SJ, Vigili MG, de Bree R, Lai SY, Alvarez J et al (2019) Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer. Head Neck 41:2655–2664. https://doi.org/10.1002/hed.25739
doi: 10.1002/hed.25739
pubmed: 30896058
van den Berg NS, Brouwer OR, Martin W, et al (2012) Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-99mTc-nanocolloid. Eur J Nucl Med Mol Imaging 39:1128-1136. https://doi.org/10.1007/s00259-012-2129-5
Hasegawa Y, Tsukahara K, Yoshimoto S, Miura K, Yokoyama J, Hirano S, et al (2019) Neck dissections based on sentinel lymph node navigation versus elective neck dissections in early oral cancers: A randomized, multicenter, non-inferiority trial. J Clin Oncol 37:15_suppl, 6007-6007. Available from: https://ascopubs.org/doi/abs/10.1200/JCO.2019.37.15_suppl.6007