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Extent of neck dissection required after concurrent chemoradiation for stage IV head and neck squamous cell carcinoma

✍ Scribed by Steven B. Cannady; Walter T. Lee; Joseph Scharpf; Robert R. Lorenz; Benjamin G. Wood; Marshall Strome; Pierre Lavertu; Ramon M. Esclamado; Jerrold P. Saxton; David J. Adelstein

Publisher: John Wiley and Sons
Year: 2009
Tongue: English
Weight: 103 KB
Volume: 32
Category: Article
ISSN: 1043-3074
DOI: 10.1002/hed.21189

No coin nor oath required. For personal study only.

✦ Synopsis

Abstract

Background

The management of initially bulky nodal disease after primary nonsurgical treatment for stage IV head and neck squamous cell carcinoma (HNSCC) continues to be a subject of debate.

Methods

A retrospective chart review of neck management in patients after chemoradiation was performed.

Results

Of the initially positive necks analyzed, 210/329 (65%) had a complete clinical response to treatment and 161 necks underwent neck surgery. Patients were pathologically positive 13.8% and 39.6% of the time after clinical complete or partial response, respectively. Regional recurrence was more frequent in necks with partial clinical (p = .04) or pathologic responses (p < .01) and with primary site recurrences (p < .01).

Conclusions

It is still safest at our institution to perform selective neck dissection on patients with ≥N2 neck disease when initially observed to prevent unsalvageable regional recurrence until more accurate interval assessment tools are confirmed. © 2009 Wiley Periodicals, Inc. Head Neck, 2010

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