Management implications of evaluating the N2 and N3 neck after organ preservation therapy.
OBJECTIVE
To determine if metastatic squamous cell carcinoma with proliferative potential persists in N2 and N3 necks after conventional radiation.


METHODS
Retrospective case series.


METHODS
We identified 17 patients from our head and neck tumor database who underwent organ-preserving radiotherapy for primary aerodigestive squamous cell cancer and N2-3 regional metastasis. Archival tissue from these 17 neck specimens was evaluated for routine histopathologic evidence of tumor, as well as immunohistochemically for cytokeratin and Ki-67 activity. An assay for apoptosis was also performed on 10 of the specimens.


RESULTS
Routine H&E evaluation suggested metastatic cancer in 11 of 17 irradiated neck specimens. Cytokeratin immunostaining confirmed squamous cell carcinoma in these 11 necks as well as 1 additional specimen that had tested H&E negative. Ki-67 staining demonstrated proliferating tumor in 3 of 17 necks. The apoptosis assay confirmed regions of apoptosis in all of the specimens analyzed.


CONCLUSIONS
The discovery of proliferating cancer cells in 3 of 17 irradiated specimens (18%) supports the practice of planned neck dissection after primary radiotherapy for patients with pretherapeutic N2+ metastatic disease.
Strasser
M D
MD
Department of Otolaryngology and Head and Neck Surgery, The University of Cincinnati Medical Center, Ohio 45267-0528, USA.
Gleich
L L
LL
Miller
M A
MA
Saavedra
H I
HI
Gluckman
J L
JL
D017209:Apoptosis; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D002455:Cell Division; D006651:Histocytochemistry; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D020287:In Situ Nick-End Labeling; D008197:Lymph Node Excision; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies