1. Neck Cancer Head and STATEMENTS ON January 28, 2006 Frankfurt am Main, Germany Surgery Management of Lymph Node Metastases

2. Moderator – Jatin Shah Speaker – Jochen Werner Panelists – Klaus Ehrenberger Miljenko Bura Jeffrey Myers

3. Management of Lymph Node Metastases Jochen Werner, M.D.

4. Cancer of the Head & Neck The success of the treatment of head and neck cancer is directly related to the STAGE of the tumor at the time of treatment.

5. Cancer of the Head & Neck The single most important prognostic factor in squamous carcinoma of the head and neck is the status of the CERVICAL LYMPH NODES.

6. Five Year Survival Rates in Patients with SCC of the Upper Aerodigestive Tract in Relation to the Extent of Disease

7. 1) Incidence 2) Nodal Factors Affecting Prognosis 3) ‘N’ Staging (AJCC-UICC-2002) 4) Diagnostic Imaging 5) Management of the N+ Neck 6) Management of the N 0 Neck 7) Adjuvant Therapy 8) The Post Chemo/R.T. Neck 9) Future Strategies Current Issues in the Management of the Neck

8. 2. Patterns of Neck Metastases N 0 Neck 3. Means of Identification of Occult Metastases 5. Extent of Treatment for Occult Metastases 1. Risk of Occult Metastases 4. Means of Treatment of Occult Metastases 6. Outcomes of Treatment of Occult Metastases

9. Preoperative 99mTC Labeled Sulfur Colloid Scan Showing Sentinel Node in the Left Lower Neck

10. The Hand-held Gamma Probe

11. Blue Colored Sentinel Node which also had a High Radioactive Count

12. Increasing Accuracy of Identifying Occult Metastasis by Various Pathologic Techniques

13. Structural (CT/MRI) Clinical Assessment of Neck Nodes After RT or Chemo/RT Functional (PET)

14. Chemo/RT (6 wks) Poor response PCRT (Post Chemo-Radiotherapy) ND (CND? Or SND?) Neck Node Protocol (N+) Good response (? Induration) 6 wks PET scan Negative observe Positive ND (CND? Or SND?)

15. 2. Means of Treatment of Gross Metastases N + Neck 3. Extent of Treatment for Gross Metastases 1. Means of Identification of Extent of Nodal Metastases 4. Indications for Adjuvant Treatment 5. Means of Adjuvant Treatment RT vs Chemo/RT 6. Complications/Sequelae of Treatment 7. Outcomes of Treatment for Gross Metastases