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Management of the neck in a randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer
Author(s) -
Lavertu Pierre,
Adelstein David J.,
Saxton Jerrold P.,
Secic Michelle,
Wanamaker John R.,
Eliachar Isaac,
Wood Benjamin G.,
Strome Marshall
Publication year - 1997
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/(sici)1097-0347(199710)19:7<559::aid-hed1>3.0.co;2-6
Subject(s) - medicine , radiation therapy , neck dissection , head and neck cancer , chemoradiotherapy , stage (stratigraphy) , surgery , chemotherapy , cancer , radiology , paleontology , biology
Background Treating the neck after organ‐preservation treatment with radiotherapy or chemoradiotherapy can be problematic. Methods To develop management guidelines, we reviewed the results of a 100‐patient phase‐3 trial that had compared outcome after radiotherapy alone with outcome after chemoradiotherapy for head and neck cancer. Patients were randomly assigned to receive radiotherapy alone or concurrent chemoradiotherapy. After completing therapy, patients were reassessed, and surgery was recommended for persistent disease at the primary site or neck and for all patients with stage N2–3 neck nodes regardless of clinical response. Results Of the 47 patients with stage N0–1, 43 had a complete response (CR); of the 18 N1 patients, all but 4 had a CR. One of these 4, as well as 5 others among the N0–1 patients, underwent neck dissection ( n = 6). No disease was found on pathologic examination, and no patient had neck recurrence. Of the remaining 41 N0–1 patients, 3 had disease progression and received no further therapy. Of the 38 others, 4 had neck recurrence, with 3 recurring at the primary site. Of the 53 with stage N2–3, 23 had less than a complete response (