Abstract
Background
Primary chemoradiation is a frequent treatment for locoregionally advanced head and neck squamous cell carcinoma. Some authors claim that a neck dissection (ND) is necessary in N2/N3 disease after this treatment in order to avoid regional recurrences. The aim of this study was to determine the incidence of isolated nodal failure in patients with N2/N3 disease who achieved a complete clinical and radiological response (CR) after chemoradiation, when no planned ND was performed.
Methods
We retrospectively analysed the survival rates, nodal response and subsequent neck nodal control of 28 patients with locally advanced oropharynx, hypopharynx or larynx squamous cell carcinoma disease, treated with primary chemoradiation.
Results
With a median follow-up of 28 months, 2-year global survival was 73% and disease-free survival 60%. Patients who had complete local and regional response after chemoradiotherapy were followed, with 100% neck nodal control.
Conclusion
Patients with N2/N3 disease who obtained a clinical and radiological CR to chemoradiation had a zero incidence of isolated neck failure without a planned ND. The continued use of planned NDs in this patient subset may not be justified. This can be further confirmed in randomised prospective trials.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Pignon JP, Bourhis J, Domenge C et al (2000) Chemotherapy added to local treatment for Head and neck Squamous Cell Carcinoma: three metaanalysis of updated individual data. MACH-NC Collaborative Group. Lancet 355:949–955
Mendenhall WM, Million RR, Cassisi NJ et al (1986) Squamous cell carcinoma of the head and neck treated with radiation therapy: the role of neck dissection for clinically positive neck nodes. Int J Radiat Oncol Biol Phys 12:733–740
Lavertu P, Adelstein D, Saxton J et al (1997) 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. Head Neck 19:559–566
Stenson K, Haraf D, Pelzer H et al (2000) The role of cervical lymphadenectomy after aggressive concomitant chemoradiotherapy: the feasibility of selective neck dissection. Arch Otolaryngol Head Neck Surg 126:950–956
McHam S, Adelstein D, Rybicki S et al (2003) Who merits a neck dissection after definitive chemoradiotherapy for N2-N3 squamous cell head and neck cancer? Head Neck 25:791–798
Brizel D, Prosnitz R, Hunter S et al (2004) Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head and neck cancer. Int J Radiat Oncol Biol Phys 58: 1418–1423
Argiris A, Stenson K, Brockstein B et al (2004) Neck dissection in the combined-modality therapy of patients with locoregionally advanced head and neck cancer. Head Neck 26:447–455
Goguen L, Posner M, Tishler R et al (2006) Examining the need for neck dissection in the era of chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 132:526–531
Pelliteri PK, Ferlito A, Rinaldo A et al (2006) Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: is it necessary for all? Head Neck 28:166–175
Homma A, Furuta Y, Oridate N et al (2006) “Watch and see” policy for the clinically positive neck in head and neck cancer treated with chemoradiotherapy. Int J Clin Oncol 11:441–448
Peters LJ, Weber RS, Morrison WH et al (1996) Neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy. Head Neck 18:552–559
Forest V, Nguyen-Tan P, Tabet JC et al (2006) Role of neck dissection following concurrent chemoradiation for advanced head and neck carcinoma. Head Neck 28:1099–1105
Grabenbauer G, Rödel C, Ernst-Stecken A et al (2003) Neck dissection following radio chemotherapy of advanced head and neck cancer — for selected cases only? Radiother Oncol 66:57–63
Yeung A, Liauw S, Amdur R et al (2008) Lymph node-positive head and neck cancer treated with definitive radiotherapy. Can treatment response determine the extent of neck dissection? Cancer 112:1076–1082
Robbins KT, Wong FS, Kumar P et al (1999) Efficacy of targeted chemoradiation and planned selective neck dissection to control bulky nodal disease in advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 125:670–675
Corry J, Peters S, Fisher R et al (2008) N2-N3 N3ck nodal control without planned neck dissection for clinical/radiologic complete responders — results of Trans Tasman Radiation Oncology Group Study 98.02. Head Neck 30:737–742
Greven KM, Williams DW Browne D et al (2008) Radiographic complete response on post treatment CT imaging eliminates the need for adjuvant neck dissection after treatment for node positive HNC. Am J Clin Oncol 31:169–172
Nayak J, Walkevar R, Andrade R et al (2007) Deferring planned neck dissection following chemoradiation for stage IV head and neck cancer: the utility of PET-CT. Laryngoscope 117: 2129–2134
Ong SC, Schöder H, Lee NY et al (2008) Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced HNC. J Nucl Med 49:532–540
Isles MG, McConkey C, Mehanna HM et al (2008) A systematic review and meta-analysis of the role of PET in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol 33:210–222
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
López Rodríguez, M., Cerezo Padellano, L., Martín Martín, M. et al. Neck dissection after radiochemotherapy in patients with locoregionally advanced head and neck cancer. Clin Transl Oncol 10, 812–816 (2008). https://doi.org/10.1007/s12094-008-0294-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-008-0294-6