Background:
Metastatic neck nodes in patients with squamous cell carcinoma of the head and neck are most commonly managed by surgery, radiotherapy, or combined-modality therapy. for combined-modality cases, the sequencing of surgery and radiotherapy is generally guided by which modality is considered preferable for treatment of the primary tumor. a postradiotherapy neck dissection is often considered for those patients with > n1 disease in which the primary is treated with radiotherapy alone.
Methods:
Between february 1991 and october 1995, 25 patients with node-positive squamous cell carcinoma of the head and neck were treated with planned unilateral (n = 22) or bilateral (n = 3) neck dissection following high-dose radiotherapy. the primary tumor sites included: tongue base (n = 11), tonsil (n = 6), nasopharynx (n = 3), pyriform sinus (n = 2), supraglottic larynx, (n = 1), soft palate (n = 1), and unknown head and neck primary (n = 1). the specific nodal stage breakdown of the 28 individual neck dissections (25 patients) was n1 (n = 1), n2a (n = 5), n2b (n = 15), n3 (n = 7).
Results:
Nineteen of the 28 neck dissections (68%) demonstrated no evidence of residual carcinoma. of the nine positive neck dissections, six revealed malignant cells in a single nodal echelon. the 1- and 2-year rate of neck control in all 25 patients was 100% and 93%, respectively. the 1- and 2-year disease-specific survival for all 25 patients was 83% and 60%, respectively. with a minimum follow-up of 2 years, 64% of the 25 patients remain alive with no evidence of disease or dead of non-cancer causes.
Conclusion:
In this series of postradiotherapy neck dissections, two thirds of the dissections demonstrated no evidence of residual tumor (19/28, or 68%). however, there was not a direct correlation between pretreatment nodal size (neck staging), radiation dose delivered, and the likelihood of achieving a cancer-free neck dissection. only one of 28 postradiotherapy neck dissections identified tumor outside of nodal stations ii-iv. the predictable pattern of residual disease in pathologically positive cases suggests that a selective neck dissection encompassing levels ii-iv may be appropriate in a majority of patients.