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Combined Radiotherapy With Planned Neck Dissection for Small Head and Neck Cancers With Advanced Cervical Metastases
Author(s) -
Wang Steven J.,
Wang Marilene B.,
Yip Helena,
Calcaterra Thomas C.
Publication year - 2000
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200011000-00003
Subject(s) - medicine , radiation therapy , neck dissection , stage (stratigraphy) , surgery , head and neck cancer , biopsy , radiology , dissection (medical) , medical record , head and neck , retrospective cohort study , cancer , paleontology , biology
Background We have previously described our treatment algorithm for patients with small head and neck cancers with advanced cervical metastases (stage N2 or greater). Primary radiotherapy is given to the primary site and neck, followed 6 weeks later with endoscopy and biopsy of the primary site. If biopsy of the primary site is negative by frozen section, an immediate neck dissection is performed even when no clinical residual neck disease is present. Our initial review found that 36% of patients with a complete clinical response to radiotherapy had positive nodes on histological examination. Study Design Retrospective. Methods The medical records of 71 patients treated at UCLA Medical Center from 1986 to 1999 by this algorithm were reviewed. Results After radiotherapy, 69 of 71 patients had a complete response at their primary site. Forty‐two patients had a complete clinical response in the neck. Seventy‐one neck dissections were performed. Overall, 31 of 71 neck dissections (44%) had positive nodes. Among the 42 patients with a complete response to radiotherapy, 13 (31%) had positive histological nodes. Among the 29 patients with a partial response to radiotherapy, 17 (59%) had positive nodes. Follow‐up and incidence of neck recurrence are discussed. Conclusion Planned neck dissection for advanced cervical metastases remains controversial for patients with a complete clinical response to radiotherapy. However, our results suggest that clinical assessment after radiotherapy cannot assure the absence of neck disease. Until there are reliable methods to distinguish which patients are truly free of neck disease, we believe the benefits of a planned neck dissection outweigh the low morbidity of this procedure.