Does clinical and radiological response predict complete tumor control in N2-N3 squamous cell head and neck cancer after non-operative management of the neck?
CONCLUSIONS
A complete clinical and radiological response observed following chemotherapy and radiotherapy is not predictive of the absence of residual disease. Moreover, salvage neck surgery does not always seem to be an effective strategy. Consequently, early neck dissection should be advised for patients with complete clinical and radiological response (CCRR) after chemoradiotherapy for tumors with N2-N3 disease.


BACKGROUND
We retrospectively reviewed the outcome of 28 patients with N2-N3 disease treated initially with chemotherapy and radiotherapy.


METHODS
A neck dissection was performed for all patients with residual disease in the neck.


RESULTS
A CCRR in the neck was achieved in 25 of 28 patients. The remaining three patients with residual neck mass underwent a salvage neck dissection: the pathological examination confirmed the persistence of tumoral disease. No regional failure was observed in these three patients. In 25 patients considered to have CCRR in the neck, 5 patients (20%) developed regional recurrence. Successful salvage approach was not possible for any of these patients.
Dequanter
Didier
D
Department of Surgery, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium. didier.dequanter@bordet.be
Lothaire
Philippe
P
Awada
Ahmad
A
Lalami
Yassine
Y
Hien Nguyen
Thi
T
Lemort
Marc
M
Vandevelde
Luc
L
Andry
Guy
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis*; D010039:Otorhinolaryngologic Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D011867:Radioisotope Teletherapy; D012189:Retrospective Studies; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed
D003037:Cobalt Radioisotopes; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil