Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation.
OBJECTIVE
To determine the efficacy of selective and superselective neck dissection for patients with bulky or residual nodal metastasis treated with concomitant intra-arterial cisplatin and radiotherapy.


METHODS
Prospective study.


METHODS
University of Tennessee, Memphis.


METHODS
A total of 240 patients with stage III or IV head and neck squamous cell carcinoma.


METHODS
Treatment with cisplatin, 150 mg/m2 intra-arterially, and sodium thiosulfate, 9 g/m2 intravenously, weekly for 4 weeks; and radiotherapy, 2 Gy per fraction per day, 5 times weekly, for a total of 68 to 74 Gy over 6 to 7 weeks.


METHODS
Regional control, distant metastases, and overall survival for patients undergoing radical or modified radical neck dissection (n = 12), selective neck dissection (n = 65), and superselective neck dissection (levels II-III only) (n = 7).


RESULTS
Among the total group of 240 patients, 106 neck dissections were performed on 84 patients who had bulky nodal disease. With a median follow-up of 58 months (range, 12-96 months), regional failure occurred in 11 (4.6%) of 240 patients: 2 (17%) of the 12 who had modified radical neck dissection, 3 (5%) of the 65 who had selective neck dissection, none of the 7 patients who had superselective neck dissection, and 6 (4%) of the 156 who had no neck dissection. The rates of overall survival and distant metastases were not significantly different among the 3 neck dissection subsets.


CONCLUSIONS
Selective and superselective neck dissection, which spare function and minimize morbidity, are viable therapeutic alternatives for patients with residual disease confined to 1 level after intra-arterial chemoradiation treatment, and possibly for other chemoradiation protocols.
Robbins
K Thomas
KT
Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield 62794-9662, USA. trobbins@siumed.edu
Doweck
Ilana
I
Samant
Sandeep
S
Vieira
Francisco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008207:Lymphatic Metastasis; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000556:secondary / Q000628:therapy*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002945:Cisplatin