Sentinel Node Biopsy for Oral Cavity Cancer: “Go or No Go”

PROGRAM DESCRIPTION: Sentinel node biopsy (SNB) is established as standard of care for breast cancer and melanoma. In oral cavity carcinoma, elective neck dissection is recommended due to an approximately 30% chance of occult nodal metastases. As such, greater than 2/3rds of patients undergoing elective neck dissection for oral cavity carcinoma have no evidence of nodal involvement on final pathology. SNB addresses this issue. SNB is widely used in Europe and parts of Asia for oral cavity carcinoma and has been adopted in select centers in the United States. It has been supported by NCCN guidelines for 10 years but not widely adopted in the US. This topic is particularly timely as an international, multi-institutional randomized prospective clinical trial addressing the role of SNB in oral cavity cancer opened in July 2020 (NRG-HN006). NRG-HN006 reached a planned hiatus on December 26, 2024 upon reaching the target enrollment of 258 patients for the Phase II portion of the trial. The temporary closure is anticipated to last 6 months in order to complete the required time points for a patient-reported outcome instrument that will serve as the basis for the Go/No Go decision for the trial to proceed to the Phase III. It is anticipated that the Go/No Go decision will be released just prior to Annual Meeting which will enhance the timeliness of this course.

This expert series will focus on the role of SNB in the management of oral cavity carcinoma. This will be evidence-based with review of the major multi-institutional trials on the topic. The benefits and limitations will be reviewed, including perceived roadblocks that have slowed adoption in the United States. The experienced instructors will present the newest technology and techniques as well as tips for incorporation into practice. Special emphasis will be given to understanding the workflow and coordination required among multiple teams, including surgery, nuclear medicine, and pathology. Finally, an update on NRG-HN006 will be provided.

OUTCOME OBJECTIVE 1: Describe the rationale and role of sentinel node biopsy in oral cavity carcinoma

OUTCOME OBJECTIVE 2: Cite the current evidence and understand the role of future study for sentinel node biopsy in oral cavity carcinoma

OUTCOME OBJECTIVE 3: Understand techniques for performing SNB and incorporating it into practice

BACKGROUND STATEMENT: There is increasing interest in SNB in the oral cavity cancer in the US, which lags behind Europe and parts of Asia in its use. It is a particularly timely topic as an international cooperative group randomized clinical trial addressing SNB in oral cavity opened in 2020 and is at interim analysis.

Comprehensive Otolaryngology Track Statement :