Radiographic complete response on post treatment CT imaging eliminates the need for adjuvant neck dissection after treatment for node positive head and neck cancer.
OBJECTIVE
The primary purpose of this study was to correlate radiographic response in the neck to clinical outcomes for patients with node positive head and neck cancer.


METHODS
One hundred three patients with stage III/IV node positive cancer were treated with definitive radiotherapy or chemoradiation at a single institution from 1990 to 2004. Follow-up ranged from 8 months to 144 months with a median of 42 months. Posttreatment CT scans were called complete radiographic response (rCR) or partial radiographic response.


RESULTS
Actuarial 36 month rates of survival, control above the clavicles, and nodal control were 66%, 74%, and 90%, respectively. Patients, who had rCR on posttreatment CT scan, who had a neck dissection had a nodal control rate of 94% compared with those without neck dissection of 97%. Patients with partial radiographic response who were treated with neck dissection had a nodal control rate of 94% compared with those without neck dissection of 73%.


CONCLUSIONS
Based on this data, there was no suggestion that neck dissection improved outcome for patients with rCR on posttreatment imaging 4 to 6 weeks after radiation.
Greven
Kathryn M
KM
Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. kgreven@wfubmc.edu
Williams
Daniel W
DW
Browne
J Dale
JD
McGuirt
W Fred
WF
White
Douglas R
DR
D'Agostino
Ralph B
RB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents