title: Planned postradiotherapy neck dissection: Rationale and clinical outcomes.
abstract: OBJECTIVE
  In this study, we examine pathology results and clinical outcome for patients with locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) who present with advanced neck disease and undergo planned postradiotherapy neck dissection.
  
  
  METHODS
  Review of all patients with SCCHN treated with primary radiation (or chemoradiation) and postradiotherapy neck dissection at the University of Wisconsin between 1992 to 2005 was performed. One hundred seven neck dissections were identified in 93 patients, 79 unilateral and 14 bilateral. All major treatment and outcome parameters were examined with particular emphasis on the postradiotherapy neck dissection.
  
  
  RESULTS
  Thirty of 107 neck dissection specimens (28%) showed evidence of residual carcinoma on pathologic review. The mean number of lymph nodes identified at neck dissection for the entire cohort was 21 per specimen (range, 1-60) with 1.3 nodes per positive neck dissection demonstrating residual carcinoma. No correlation was found between the type of neck dissection performed and the presence of residual nodal disease. Eighty-two evaluated patients (93%) remain free of regional disease recurrence, whereas six patients have subsequently manifested neck recurrence. Four of the six patients who developed regional recurrence showed residual carcinoma in their neck dissection specimen. Five of these patients underwent comprehensive neck dissection (levels I-V); one underwent selective neck dissection (<levels I-V).
  
  
  CONCLUSIONS
  Approximately one-fourth of the patients in this series showed pathologic evidence of residual carcinoma in the neck at the time of postradiotherapy neck dissection. The majority of these cases showed microscopic residual carcinoma in a single lymph node. Although in the early postradiotherapy setting, we cannot accurately predict the viability and growth potential of microscopic residual carcinoma in lymph nodes, these findings, combined with the modest overall morbidity of selective neck dissection, suggest that planned postradiotherapy neck dissection should be strongly considered for patients presenting with advanced neck disease. This remains a prevailing clinical practice at our institution.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792, USA.
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Sewall
authors.forename: Kerrin L
authors.initials: KL
authors.lastname: Palazzi-Churas
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Richards
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Hartig
authors.forename: Paul M
authors.initials: PM
authors.lastname: Harari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011183:Postoperative Complications; D012189:Retrospective Studies