title: Planned postradiotherapy neck dissection in patients with advanced head and neck cancer.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison 53792-0600, USA.
authors.forename: T S
authors.initials: TS
authors.lastname: Boyd
authors.forename: P M
authors.initials: PM
authors.lastname: Harari
authors.forename: S P
authors.initials: SP
authors.lastname: Tannehill
authors.forename: M C
authors.initials: MC
authors.lastname: Voytovich
authors.forename: G K
authors.initials: GK
authors.lastname: Hartig
authors.forename: C N
authors.initials: CN
authors.lastname: Ford
authors.forename: R L
authors.initials: RL
authors.lastname: Foote
authors.forename: B H
authors.initials: BH
authors.lastname: Campbell
authors.forename: C J
authors.initials: CJ
authors.lastname: Schultz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D009333:Neck / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D009382:Neoplasms, Unknown Primary / Q000532:radiotherapy / Q000601:surgery; D010157:Palatal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D010347:Patient Care Planning; D010610:Pharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011879:Radiotherapy Dosage; D013529:Surgical Wound Dehiscence / Q000209:etiology; D015996:Survival Rate; D014062:Tongue Neoplasms / Q000532:radiotherapy / Q000601:surgery; D014067:Tonsillar Neoplasms / Q000532:radiotherapy / Q000601:surgery; D014945:Wound Healing