Postradiotherapy neck dissection for head and neck squamous cell carcinoma: pattern of pathologic residual carcinoma and prognosis.
BACKGROUND
For patients with head and neck cancer who were treated using primary radiotherapeutic approaches, the pattern of pathologic residual carcinoma in the neck dissection specimen and its effect on clinical outcome remains unknown.


METHODS
Medical records of 65 patients who underwent 71 neck dissections a median 7 weeks after radiotherapy were reviewed. Median follow-up was 33 months.


RESULTS
Residual cancer, identified in 28 patients (43%), diminished locoregional control (p = .018), recurrence-free (p = .018), and overall survival (p = .02). Thirteen patients (20%) had 2 or more pathologically involved lymph nodes. Nine (13%) involved level V. Four (6%) had pathologic involvement of nodal levels not clinically involved by cancer before treatment. In N2-3 patients with positive pathologic specimens, the presence of these factors diminished recurrence-free survival (p = .01). The outcome of patients with pathologic carcinoma but without such ominous factors approached those with negative pathology.


CONCLUSIONS
For patients with residual carcinoma in the neck following radiation, the pattern of residual disease is an effective predictor of recurrence.
Lango
Miriam N
MN
Division of Head and Neck Cancer, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA. Miriam.Lango@fccc.edu
Andrews
Genevieve A
GA
Ahmad
Sidrah
S
Feigenberg
Steven
S
Tuluc
Madalina
M
Gaughan
John
J
Ridge
John A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual; D011183:Postoperative Complications; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis