Purpose:
The aim of this study was to define the role of neck dissection during surgery for patients who have received elective nodal irradiation in the course of treatment for a prior squamous cell carcinoma of the head and neck (scchn) and are subsequently diagnosed with a second primary scchn.
Materials and methods:
We reviewed the medical records of 13 patients who received both definitive radiotherapy and elective nodal irradiation for t1-4 n0 m0 scchn of the oral cavity, oropharynx, hypopharynx, or larynx who then subsequently developed a metachronous t1-4 n0 m0 scchn primary at a new site. all second primary tumors were treated with surgery. ten of the 13 patients also received an elective neck dissection (end) at that time: 7 unilateral and 3 bilateral. we report the outcomes for the patients in this series.
Results:
One (8%) of 13 neck dissection specimens was positive in 1 (10%) of 10 patients. the 5-year outcomes were the following: local-regional control, 67%; local control, 77%; disease-free survival, 62%; overall survival, 38%; and cause-specific survival rate, 77%. six patients experienced treatment-related complications of grade 2 or higher (per common terminology criteria for adverse events, version 4). complications occurred exclusively in patients who received an end.
Conclusions:
The risk of occult nodal disease may be low enough to justify omitting an end for a second primary scchn in selected patients while maintaining treatment efficacy and reducing patient morbidity. larger studies on this subject are needed to further address this question.