Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: is it necessary for all?
In the absence of large-scale randomized trials evaluating dissection versus observation of the involved neck after neoadjuvant chemoradiotherapy, there is a need to collect data that will either support or ultimately refute a role for planned posttreatment neck dissection. A significant percentage of patients with extensive (N2 or N3) neck disease who demonstrate a complete response to chemoradiation therapy may harbor residual occult metastases, and identification of this subset of patients remains a clinical challenge. Because surgical salvage rates are greatly diminished when occult nodal disease becomes clinically manifest, planned posttreatment neck dissection is advocated but may not be necessary in all patients. The role of positron emission tomography chemoradiotherapy (PET-CT) in this scenario remains unproven but holds promise in being able to identify which patients may be harboring residual disease in the neck after chemoradiotherapy. The implementation of as yet unidentified molecular tumor markers in combination with PET-CT may ultimately prove to be effective in identifying patients who will best benefit from posttherapy neck dissection. Correlation of imaging results and pathologic node status will be important in determining the accuracy and, therefore, the value of this imaging modality for predicting the presence or absence of residual disease.
Pellitteri
Phillip K
PK
Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
Ferlito
Alfio
A
Rinaldo
Alessandra
A
Shah
Jatin P
JP
Weber
Randal S
RS
Lowry
John
J
Medina
Jesus E
JE
Gourin
Christine G
CG
Robbins
K Thomas
KT
Suárez
Carlos
C
Shaha
Ashok R
AR
Genden
Eric M
EM
Leemans
C René
CR
Lefebvre
Jean Louis
JL
Kowalski
Luiz P
LP
Wei
William I
WI
D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D037981:Neck Dissection; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000601:surgery; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014055:Tomography, Emission-Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18