Role of planned postchemoradiotherapy selective neck dissection in the multimodality management of head and neck cancer.
OBJECTIVE
To assess the oncologic efficacy and functional outcome of selective postchemoradiotherapy neck dissection for stage IV head and neck squamous cell carcinoma.


METHODS
Retrospective review of patients with N2-3 cervical metastases at presentation who underwent planned neck dissection after complete biopsy-proven clearance of primary site mucosal disease with chemoradiotherapy between 2000 and 2006.


RESULTS
There were 31 males and 10 females. The average age at presentation was 57 +/- 9 years. The oropharynx was the most common primary site (n = 23; 56%). Forty-nine hemineck dissections were performed, including six bilateral and two revision procedures. Sixteen (39%) patients had residual viable postchemoradiotherapy neck disease. Patient weight did not deteriorate after neck dissection (P > .4). Two patients had persistently worsened postoperative swallowing. Ten patients required shoulder physiotherapy, of whom eight were treated with conservative measures. Five-year hemineck disease control and disease-specific survival rates were 92% and 64%, respectively. Presence of viable postchemoradiotherapy neck disease was the only independent predictor of regional control (P < .001; hazard ratio 0.00; 0.00-0.40) and disease-specific survival (P < .02; hazard ratio 0.23; 0.04-0.55). Surgery was twice more likely to confer therapeutic benefit than to cause a significant, albeit in most cases, transitory, complication.


CONCLUSIONS
Neck dissection is a safe and effective procedure and a necessary component of the multimodality management of all head and neck cancer patients with N2-3 disease. It should be performed soon after satisfactory demonstration of primary site disease clearance. Universal deployment of radical surgery appears unnecessary and should, when possible, be abandoned in favor of more selective procedures to lessen morbidity.
Department of Otolaryngology, Charing Cross Hospital, London, UK. RN@cantab.net
S A Reza
SA
Nouraei
Tahwinder
T
Upile
Chadwan
C
Al-Yaghchi
Guri S
GS
Sandhu
Simon
S
Stewart
Peter M
PM
Clarke
Ann
A
Sandison
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D003710:Demography; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D006285:Health Planning; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents