title: Neck dissection for advanced lymph node metastasis before definitive radiotherapy for primary carcinoma of the head and neck.
abstract: OBJECTIVE
  To evaluate the outcome of neck dissection for advanced metastasis and subsequent planned radiotherapy to the neck and primary tumor.
  
  
  METHODS
  Single-center, retrospective case series.
  
  
  METHODS
  From 1988 to 1998, 37 previously untreated patients were included into the study protocol. Two had a single tumor-positive neck node and the remaining 35 had multiple tumor-positive neck nodes (mean number, 6.0). Extranodal spread was reported in 35 cases (95%); mean nodal size was 5.7 cm (SD, 2.4 cm). Five patients (14%) were not irradiated or were irradiated with palliative intention. Of the remaining patients, 30 received irradiation of 60 Gy or more to the neck and the primary tumor (mean dose, 66.9 Gy; SD, 4.2 Gy). Cumulative survival distributions were estimated by the Kaplan-Meier method, and differences between groups were analyzed with the log-rank test.
  
  
  RESULTS
  Treatment-related mortality was observed in three patients (8%). Disease-specific survival was 49% at 2 years and the overall locoregional control rate was 43% at 2 years. Patients with T1 to T2 primary lesions were compared with those with advanced primary disease, and the 2-year local control rates were 76% and 47%, respectively (P = .056). The following prognostic factors were identified for distant metastasis: three or more positive nodes (P = .037), positive surgical margins in the neck dissection specimen (P = .004), and time from diagnosis until neck dissection of 23 days or more (P = .043). The influence of distant metastasis on disease-specific survival was evident (P = .0003).
  
  
  CONCLUSIONS
  Patients with low-T-stage tumors have a better local control rate with this regimen and survival depends on the status of the neck.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: L E
authors.initials: LE
authors.lastname: Smeele
authors.forename: C R
authors.initials: CR
authors.lastname: Leemans
authors.forename: C B
authors.initials: CB
authors.lastname: Reid
authors.forename: R
authors.initials: R
authors.lastname: Tiwari
authors.forename: G B
authors.initials: GB
authors.lastname: Snow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome