Do neck levels negative on initial CT need to be dissected after definitive radiation therapy with or without chemotherapy?
BACKGROUND
The extent of the adjuvant neck dissection after radiotherapy with or without chemotherapy remains undefined. We investigated whether we could limit neck dissection to levels with positive lymph nodes on CT scan before treatment.


METHODS
Twenty-one patients' initial diagnostic CT scans were reviewed retrospectively and neck levels were scored positive for malignancy if the respective lymph nodes met any of the following: maximum axial diameter >1 cm; oval/round shape; hypodensity; presence of extracapsular penetration; and irregular enhancement. Patients were treated with radiation alone (71%) or with radiation plus chemotherapy (29%). Neck dissection consisted of radical (8 heminecks), modified radical (4 heminecks), or selective (13 heminecks).


RESULTS
One hundred two neck levels were dissected. Of these, 56 levels (54.9%) were negative on initial CT scan. None of them was found to contain cancer.


CONCLUSIONS
After radiation with or without chemotherapy, neck dissection of an initially negative neck level may not be necessary. Neck dissection may target only initially positive levels.
Department of Radiation Oncology, University of Texas Medical Branch, Galveston, Texas, USA. ngrao@utmb.edu
Nikhil G
NG
Rao
Giuseppe
G
Sanguineti
Gregory
G
Chaljub
Shawn D
SD
Newlands
Suimin
S
Qiu
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed