Faculty Collaboration Database

Planned postradiotherapy neck dissection in patients with advanced head and neck cancer. Head Neck 1998 Mar;20(2):132-7

Date

03/04/1998

Pubmed ID

9484944

DOI

10.1002/(sici)1097-0347(199803)20:2<132::aid-hed6>3.0.co;2-3

Scopus ID

2-s2.0-0031908690 (requires institutional sign-in at Scopus site)   99 Citations

Abstract

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.

Author List

Boyd TS, Harari PM, Tannehill SP, Voytovich MC, Hartig GK, Ford CN, Foote RL, Campbell BH, Schultz CJ

Authors

Bruce H. Campbell MD Emeritus Professor in the Otolaryngology department at Medical College of Wisconsin
Christopher J. Schultz MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell
Combined Modality Therapy
Disease-Free Survival
Follow-Up Studies
Head and Neck Neoplasms
Humans
Laryngeal Neoplasms
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Nasopharyngeal Neoplasms
Neck
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasm, Residual
Neoplasms, Unknown Primary
Palatal Neoplasms
Patient Care Planning
Pharyngeal Neoplasms
Radiotherapy Dosage
Surgical Wound Dehiscence
Survival Rate
Tongue Neoplasms
Tonsillar Neoplasms
Wound Healing