title: Treatment results on advanced neck metastasis (N3) from head and neck squamous carcinoma.
abstract: OBJECTIVE
  To analyze the long-term results of patients with N3 neck metastasis from squamous carcinoma of the head and neck.
  
  
  METHODS
  This study is based on the analysis of a retrospective cohort of 224 previously untreated patients with squamous cell carcinoma of the head and neck and lymph node metastasis sized greater than 6 cm (N3) who were evaluated from 1981 to 1996.
  
  
  RESULTS
  Fifty-four patients (24.1%) underwent neck dissection, 137 underwent radiotherapy alone (61.2%), and 33 received only supportive care (14.7%). Control of the neck metastasis was achieved in 46 cases among the treated ones (24.1%), varying from 51.9% for the patients who underwent surgery to 13.1% for radiotherapy alone ( P < 0.001). Exclusive distant metastasis occurred in 37.0% of the cases who had control of the neck disease. The 3-year overall survival rates were 17.9% for patients who underwent surgery and 7.0% for radiotherapy alone ( P = 0.003). The multivariate analysis showed as independent predictive factors the treatment approach ( P < 0.001) and tumor site ( P = 0.016).
  
  
  CONCLUSIONS
  This study confirms the poor prognosis of patients with N3 neck disease, mainly when treated by radiotherapy alone. A radical neck dissection associated with adjuvant radiotherapy is indicated whenever feasible. Because of the high rate of distant metastasis, protocols including adjuvant chemotherapy should be investigated.
authors.affiliation: Head and Neck Surgery and Otorhinolaryngology Department, Hospital do Câncer, A.C. Camargo, São Paulo, Brazil.
authors.forename: André L
authors.initials: AL
authors.lastname: Carvalho
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Ivan M G
authors.initials: IM
authors.lastname: Agra
authors.forename: Everton
authors.initials: E
authors.lastname: Pontes
authors.forename: Olimpio D
authors.initials: OD
authors.lastname: Campos
authors.forename: Antonio Cássio A
authors.initials: AC
authors.lastname: Pellizzon
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D011879:Radiotherapy Dosage