title: Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation.
abstract: 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.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield 62794-9662, USA. trobbins@siumed.edu
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
authors.forename: Ilana
authors.initials: I
authors.lastname: Doweck
authors.forename: Sandeep
authors.initials: S
authors.lastname: Samant
authors.forename: Francisco
authors.initials: F
authors.lastname: Vieira
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin