title: Neck dissection after radiochemotherapy in patients with locoregionally advanced head and neck cancer.
abstract: BACKGROUND
  Primary chemoradiation is a frequent treatment for locoregionally advanced head and neck squamous cell carcinoma. Some authors claim that a neck dissection (ND) is necessary in N2/N3 disease after this treatment in order to avoid regional recurrences. The aim of this study was to determine the incidence of isolated nodal failure in patients with N2/N3 disease who achieved a complete clinical and radiological response (CR) after chemoradiation, when no planned ND was performed.
  
  
  METHODS
  We retrospectively analysed the survival rates, nodal response and subsequent neck nodal control of 28 patients with locally advanced oropharynx, hypopharynx or larynx squamous cell carcinoma disease, treated with primary chemoradiation.
  
  
  RESULTS
  With a median follow-up of 28 months, 2-year global survival was 73% and disease-free survival 60%. Patients who had complete local and regional response after chemoradiotherapy were followed, with 100% neck nodal control.
  
  
  CONCLUSIONS
  Patients with N2/N3 disease who obtained a clinical and radiological CR to chemoradiation had a zero incidence of isolated neck failure without a planned ND. The continued use of planned NDs in this patient subset may not be justified. This can be further confirmed in randomised prospective trials.
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario de la Princesa, Madrid, Spain. mlopezrgez@yahoo.es
authors.forename: Mario
authors.initials: M
authors.lastname: López Rodríguez
authors.forename: Laura
authors.initials: L
authors.lastname: Cerezo Padellano
authors.forename: Margarita
authors.initials: M
authors.lastname: Martín Martín
authors.forename: Felipe
authors.initials: F
authors.lastname: Couñago Lorenzo
mesh_terms: D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D017211:Treatment Failure