title: Observations on control of N2 and N3 neck disease in squamous cell carcinoma of the head and neck by intra-arterial chemoradiation.
abstract: Patients with head and neck squamous cell cancer with N2 and N3 neck disease have a poor prognosis and are at risk to fail regionally despite combined surgery and radiation. Twenty-two patients with N2 and N3 neck disease (and T3-4 primaries) were treated with intra-arterial, high-dose cisplatin (CDDP), 150 mg/m2 per week for 4 weeks, and concurrent radiation. All patients were followed for at least 2 years or until death from any cause. Twenty patients had a complete response at the primary site. Two of the 20 with a complete response later had a neck recurrence and died. Five patients with palpable nodes after treatment underwent fine-needle aspiration (FNA), one of which was positive and two suggestive of cancer. Six neck dissections were performed in this group, only two of which had positive nodes. This chemoradiation protocol may offer reasonable control of N2 and N3 neck disease in advanced head and neck squamous cell cancer. Neck dissection appeared to be necessary in only those patients with nodes 8 weeks after treatment in whom FNA was positive or suggestive of cancer. Because of the relatively small size of this series, additional accrual and monitoring of such patients is planned.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, and the San Diego Veterans Administration Medical Center, 92103-8891, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Weisman
authors.forename: R D
authors.initials: RD
authors.lastname: Christen
authors.forename: V E
authors.initials: VE
authors.lastname: Jones
authors.forename: C W
authors.initials: CW
authors.lastname: Kerber
authors.forename: S L
authors.initials: SL
authors.lastname: Seagren
authors.forename: L A
authors.initials: LA
authors.lastname: Orloff
authors.forename: S L
authors.initials: SL
authors.lastname: Glassmeyer
authors.forename: S B
authors.initials: SB
authors.lastname: Howell
authors.forename: K T
authors.initials: KT
authors.lastname: Robbins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies