Conclusion

The advent of new diagnostic techniques, molecular analysis, and more accurate imaging may help identify patients with clinically undetectable lymphatic metastasis in the future. At present, however, elective treatment of lymph nodes at high risk of micrometastasis from upper aerodigestive tract cancers is warranted. Treatment should be undertaken when the risk of occult metastasis exceeds 10 to 15%. Effective treatment can be provided by means of either radiation therapy or surgery. Selective neck dissections are considered adequate for identifying lymph nodes with occult metastasis. Adjuvant radiotherapy is warranted in cases displaying the appropriate indications. The lack of improvement in survival in the patient population with occult nodal metastasis can be attributed to several factors, including false-negative pathologic examinations and inadequate adjuvant treatment. The inadequacy of currently available adjuvant treatment is shown by the lack of benefit of adjuvant chemotherapy in patients with extracapsular spread associated with lymphatic metastasis. The identification of the entire population of patients with occult metastasis and the use of directed novel adjuvant treatment, and thereby improvement in survival, remain high priorities in head and neck oncology.

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