Superselective neck dissection after chemoradiation: feasibility based on clinical and pathologic comparisons.
OBJECTIVE
To determine whether superselective neck dissection (removal of 2 or less contiguous neck levels) is effective salvage surgery for patients with residual single-level adenopathy after concomitant intra-arterial cisplatin and radiotherapy.


METHODS
Analysis of prospectively collected data.


METHODS
The study group comprised 177 patients (239 heminecks) with N+ disease.


METHODS
Intra-arterial treatment with cisplatin (150 mg/m2) on days 1, 8, 15, and 22 and radiation therapy (2 Gy/d) 5 times per week for 7 weeks. Comparisons were made between neck-level-specific disease at restaging and pathologic disease after neck dissection.


RESULTS
Tumor sites included oropharynx (n = 81), hypopharynx (39), larynx (n=27), oral cavity (n = 19), and other (n = 11). Response of nodal disease based on clinical evaluation was as follows: complete response, 89 patients (50%); partial response, 81 patients (46%); progressive disease, 4 patients (2%); and unevaluable, 3 patients (2%). Of the 89 patients whose necks were restaged as a partial response, 73 had clinical evidence of residual adenopathy involving only 1 neck level. Within this subset, 54 patients (57 heminecks) subsequently underwent a salvage neck dissection, for which comparisons were made between the restaging evidence of residual adenopathy and the pathologic findings that were specific for each neck level. Only 2 of the 54 patients had evidence of pathologic disease extending beyond the single neck level: one had disease in a contiguous neck level, and the other had disease in a noncontiguous level. The use of superselective neck dissection with removal of only 2 contiguous neck levels would have encompassed known disease in all but 1 patient.


CONCLUSIONS
Superselective neck dissection is feasible after this specific chemoradiation protocol has been administered to patients with persistent nodal disease that is confined to 1 level.
Robbins
K Thomas
KT
Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9677, USA. trobbins@siumed.edu
Shannon
Kerwin
K
Vieira
Francisco
F
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D037981:Neck Dissection / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D011879:Radiotherapy Dosage