Long-term neck control rates after complete response to chemoradiation in patients with advanced head and neck cancer.
OBJECTIVE
To examine the long-term neck failure outcome in patients with advanced head and neck cancer treated on larynx/organ preservation protocols at Memorial Sloan-Kettering Cancer Center.


METHODS
Two hundred thirteen patients were enrolled from 1983 through 1995 on larynx/organ preservation protocols receiving induction chemotherapy followed by radiotherapy alone or with concomitant chemotherapy. Eighty-six patients with node-positive disease received definitive chemoradiotherapy at Memorial Sloan-Kettering Cancer Center. A median dose of 70 Gy was delivered. The median follow-up of the surviving patients was 9 years.


RESULTS
Sixty-five patients with node-positive disease achieved a clinical complete response and were observed after chemoradiation without immediate neck dissection. The crude rate of subsequent neck failure among those patients according to initial nodal classification was: N1 14% (3 of 21), N2: 15% (6 of 40), N3: 0% (0 of 4). The median overall survival of these patients was: N1: 12.2 years; N2: 6.5 years; N3: 0.8 years. Patients who experienced a complete response to induction chemotherapy in the neck had improved overall survival (53% vs. 29%; P = 0.005) and a lower incidence of neck failure (10% vs. 24%; P = 0.14) when compared with those patients who had less than a complete response.


CONCLUSIONS
Our data suggests that in patients with advanced neck disease who have a clinical complete response in the neck to chemoradiation long-term neck control is 85% or greater without neck dissection. Whether functional imaging or treatment response to induction chemotherapy would provide better discrimination of the 10% to 15% who may experience neck relapse is an important question for future research initiatives.
Rengan
Ramesh
R
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Pfister
David G
DG
Lee
Nancy Y
NY
Kraus
Dennis H
DH
Shah
Jatin P
JP
Shaha
Ashok R
AR
Ben-Porat
Leah S
LS
Zelefsky
Michael J
MJ
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002945:Cisplatin