Neck Surgery in Treating Patients With Early-Stage Oral Cancer

SEND Trial The Role of Selective Neck Dissection Used Electively in Patients With Early Oral Squamous Cell Carcinoma (1-3cm Primary Size) and No Clinical Evidence of Lymph Node Metastases in the Neck

RATIONALE: Surgery may be an effective treatment for oral cancer. It is not yet known whether surgery to remove the tumor and lymph nodes in the neck is more effective than surgery to remove the tumor alone in treating patients with early-stage oral cancer. PURPOSE: This randomized clinical trial is comparing two types of neck surgery to see how well they work in treating patients with early stage oral cancer.

OBJECTIVES: To determine whether the use of a selective neck dissection (SEND) used electively on all patients presenting with stage I-II oral cavity squamous cell carcinoma (SCC) improves survival, disease-free survival, and loco-regional disease control rates. To determine how SEND and complex reconstruction affect quality of life and mental health. To determine whether the use of SEND on all patients presenting with stage I-II oral cavity SCC represents a cost-effective use of resources. OUTLINE: This is a multicenter study. Patients are stratified by age (< 40 vs 40-64 vs ≥ 65 years of age), tumor stage (T1 vs T2), and surgeon. Arm I: Patients undergo resection of the primary tumor with neck dissection. Arm II: Patients undergo resection of the primary tumor alone. Patients complete the EORTC QLQ-C30, EORTC QLQ - H&N35, and the Hospital Anxiety and Depression Scale (HADS) before surgery and at 6, 12, and 24 months after surgery. Patients also complete the EQ-5D questionnaire at baseline, 6 months, 12 months, and 24 months. Additionally, a self-completion Health Service Use questionnaire is completed every 2 months, during the first 24 months after treatment, to enable costs to the NHS to be monitored. After surgery, patients are followed periodically for up to 5 years. Peer Reviewed and Funded or Endorsed by Cancer Research UK.

stage I squamous cell carcinoma of the lip and oral cavity, stage II squamous cell carcinoma of the lip and oral cavity, tongue cancer

Psychological well-being as measured by the Hospital Anxiety and Depression Scale (HADS) at 6, 12, and 24 months

DISEASE CHARACTERISTICS: Patients with oral squamous cell carcinoma measuring 1 to 3 cm at the primary site No clinical or preoperative imaging evidence of nodal involvement in the neck (N0) Surgery is the primary mode of treatment Dose not need reconstruction that necessitates opening the neck, as assessed by the surgeon No cancer of the lip No prior head and neck tumor PATIENT CHARACTERISTICS: No technical, medical, or anaesthetic difficulties that preclude patients being entered into one of the trial arms Not considered to be medically, socially, or psychiatrically unfit for surgery as first-line treatment by the multidisciplinary team No other synchronous tumor No preference for non-surgical treatment PRIOR CONCURRENT THERAPY: See Disease Characteristics

Hutchison IL, Ridout F, Cheung SMY, Shah N, Hardee P, Surwald C, Thiruchelvam J, Cheng L, Mellor TK, Brennan PA, Baldwin AJ, Shaw RJ, Halfpenny W, Danford M, Whitley S, Smith G, Bailey MW, Woodwards B, Patel M, McManners J, Chan CH, Burns A, Praveen P, Camilleri AC, Avery C, Putnam G, Jones K, Webster K, Smith WP, Edge C, McVicar I, Grew N, Hislop S, Kalavrezos N, Martin IC, Hackshaw A. Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort. Br J Cancer. 2019 Nov;121(10):827-836. doi: 10.1038/s41416-019-0587-2. Epub 2019 Oct 15. Erratum In: Br J Cancer. 2022 Mar;126(5):831.