Premium
Planned postradiotherapy neck dissection in patients with advanced head and neck cancer
Author(s) -
Boyd Timothy S.,
Harari Paul M.,
Tannehill Scott P.,
Voytovich Marta C.,
Hartig Gregory K.,
Ford Charles N.,
Foote Robert L.,
Campbell Bruce H.,
Schultz Christopher J.
Publication year - 1998
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(199803)20:2<132::aid-hed6>3.0.co;2-3
Subject(s) - medicine , neck dissection , radiation therapy , head and neck cancer , larynx , surgery , tonsil , primary tumor , stage (stratigraphy) , cancer , radiology , metastasis , paleontology , biology
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. © 1998 John Wiley & Sons, Inc. Head Neck 20: 132–137, 1998.