Have most head and neck surgeons become complacent or at least tolerant of a clinical practice that is based, to a great extent, not on scientific evidence but, as Goldman et al1 recently said, on statements that begin with "In my experience...." Our likely firsthand reaction to this question is "Absolutely not!" However, if we reflect on our treatment recommendations for any given patient with cancer of the head and neck region, as I invite you to do, we will quickly realize that we simply lack conclusive evidence to support many of our most common clinical practices.
Take, for example, the treatment of a young patient with a T2N0 squamous cell carcinoma of the tongue and ponder, "Can we solidly stand behind our recommendations for treatment?"
Most of us would recommend elective treatment of the neck with either surgery or radiation, even though we will be treating, unnecessarily, 70%
Medina JE. Research and the American Society of Head and Neck Surgeons Clinical Studies in Head and Neck Oncologic Surgery. Arch Otolaryngol Head Neck Surg. 1993;119(9):1054–1055. doi:10.1001/archotol.1993.01880210154024
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